New Hampshire                                                                                                                                                        
                         Department of                          ED-02
                 Revenue Administration                                                             00ED022011862

                                              EDUCATION TAX CREDIT APPLICATION

PRINT OR TYPE                             This application is due no later than May 31 in each program year.
STEP 1
1.   Business Organization/Enterprise or Individual Name                                         5. Taxpayer Identification Number

2.   Number & Street Address                                                                                DIN                                                          FEIN SSN

      Address (continued)

3.   City / Town                              State       Zip Code + 4 (or Canadian Postal Code)

4.   Contact Name and Title                                              Contact Phone

     Contact Email

Entity 
Type:          2 - CORPORATION/COMBINED GROUP            3 - PARTNERSHIP 1 - PROP/INDIVIDUAL     5 - NON-PROFIT                                                          4 - FIDUCIARY

     STEP 2
6.   SCHOLARSHIP ORGANIZATION(S) TO WHICH YOU INTEND TO CONTRIBUTE AND AMOUNT OF EACH REQUESTED DONATION:

       A. The Children's Scholarship Fund  .......................................................................................................................      $

       B. Giving and Going Alliance  .................................................................................................................................. $

7.   TOTAL REQUESTED ELIGIBLE DONATION AMOUNT  ...................................................................................................                      $
     The maximum donation eligible for the Education Tax Credit for the Program Year is $600,000.

8.   TAX CREDIT AMOUNT (85% of donation)  ....................................................................................................................  $             0
     Tax credits awarded are 85% of the donation amount on a first come, first served basis until the statutory maximum  
     credit limit has been reached.

STEP 3
     I certify that the business organization/enterprise or that I (the individual) shall make the requested donations no later 
     than 60 days after the date of approval of this application in accordance with RSA 77-G, but no later than June 30, of 
     the program year and I declare, under penalties of perjury, that I have examined this document and to the best of my 
     belief the information is true, correct and complete.
     AUTHORIZED SIGNATURE (IN INK)

     PRINT SIGNATORY NAME & TITLE
                                                                                                 DATE

     File on line at Granite Tax Connect  www.revenue.nh.gov/gtc or mail to NH DRA, Education Tax Credit, PO Box 637, Concord NH 03302-0637

ED-02
Rev 1.7 09/2022

                New Hampshire  
                Department of                                           ED-02
               Revenue Administration

                                   EDUCATION TAX CREDIT APPLICATION INSTRUCTIONS

WHO MUST FILE?  
Business organizations, business enterprises, or individuals requesting to make a donation(s) to a qualified scholarship organization(s), in order to receive a 
tax credit, must file an Education Tax Credit Application (Form ED-02). 
  
WHEN TO FILE?  
Form ED-02 must be received by the Department of Revenue Administration no later than May 31 of each program year. 
  
WHERE TO FILE?  
File online at Granite Tax Connect www.revenue.nh.gov/gtc or mail to NH DRA, PO Box 637, Concord NH, 03302-0637. 
  
FORMS SHALL NOT BE FILED BY FAX OR EMAIL 
  
NEED HELP?  
Call the Department at (603) 230-5920, Monday through Friday, 8:00am to 4:30pm. For more information visit us on the web at: www.revenue.nh.gov. 
Hearing or speech impaired individuals may call TDD Access: Relay NH 1-800-735-2964. 
  
LINE-BY-LINE INSTRUCTIONS  
  
STEP 1 
  
Line 1 
Enter the business organization's, business enterprise's, or individual's name.  
  
Line 2 
Enter the business organization's, business enterprise's, or individual's street address.  
  
Line 3  
Enter the business organization's, business enterprise's, or individual's city, state and zip code.  
   
Line 4  
Enter the name, title, address, telephone number and email address of the contact person for the business organization,  business enterprise, or the 
individual.  The contact person should be the person the Department of Revenue Administration can contact regarding this application.  
  
Line 5  
Enter the business organization's, business enterprise's, or the individual's taxpayer identification number; Department Identification Number (DIN),  
Federal Taxpayer Identification Number (FEIN), or Social Security Number (SSN). 
  
STEP 2  
  
Line 6  
Enter the dollar amounts for each name(s) of the scholarship organization(s) that will be receiving your donation.  
  
Line 7  
Enter the total of all requested donation amounts eligible under RSA 77-G not to exceed $600,000 for the program year. 
  
Line 8  
Enter 85% of the Total Requested Donation Amount. This is the maximum amount of Education Tax Credit you may receive.  
  
STEP 3  
The application must be dated and signed in ink by an officer or authorized agent, or by the individual. In addition, print the name and title of the officer, 
authorized agent, or individual signing the application.  
  
NOTICE  
APPROVED DONATIONS MUST BE MADE TO A QUALIFIED SCHOLARSHIP ORGANIZATION NO LATER THAN 60 DAYS AFTER THE DATE OF APPROVAL OF 
THIS APPLICATION BY THE DEPARTMENT OR THE REQUEST SHALL EXPIRE.  
  
HOWEVER, DONATIONS APPROVED ON OR AFTER MAY 3 OF THE PROGRAM YEAR MUST BE MADE TO A QUALIFIED SCHOLARSHIP ORGANIZATION NO 
LATER THAN JUNE 30 OF THE PROGRAM YEAR.

ED-02
Rev 1.7 09/2022