Online Scholarship Application

Donor Information

Name

Address

Street Address Address Line 2 City State ZIP Code

Email

Phone

Tax Credit Information

Filing Status

Married Filing Jointly
Single Taxpayer

Tax Credit Year

2017
2018

Have you donated to an STO this year?

Yes
No

Total amount of $:

Donation Information

Lutheran School (Optional)

Student Recommendation (Optional)

Amount $

Payment Information

I am paying by

Check
Credit Card

make payable to ALSO #:

Name as it appears on card

Card Number

Expiration Date

Security Code/CCV

Signature

Date

How did you hear about ALSO?

What church do you attend?

Send completed form to

Arizona Lutheran Scholarship Organization
PO Box 13277, Chandler, AZ 85248
NOTICE: A school tuition organization cannot award, restrict, or reserve scholarships only on the basis of a donor’s recommendation. A taxpayer may not claim a tax credit if the taxpayer agrees to swap donations with another taxpayer to benefit either taxpayer’s own dependent. A.R.S. 43-1603 (C). Any designation of your own dependent as a potential recipient is prohibited

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