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State of Rhode Island Division of Taxation
Form CSO-1
Scholarship Organization Qualification Application
TAX CREDITS FOR CONTRIBUTIONS TO SCHOLARSHIP ORGANIZATIONS
SCHOLARSHIP ORGANIZATION QUALIFICATION APPLICATION
TO CERTIFY BY DECEMBER 31, 2021 ELIGIBILITY TO PARTICIPATE IN THIS PROGRAM IN 2022
NAME
Scholarship ADDRESS
Organization CITY STATE ZIP CODE
Information
FEDERAL IDENTIFICATION NUMBER TAX YEAR END DATE
NAME TITLE
Contact PHONE NUMBER FAX NUMBER
Information
EMAIL ADDRESS
NAME PHONE NUMBER
EMAIL ADDRESS
Additional
Contact
NAME PHONE NUMBER
Information
EMAIL ADDRESS
Under penalties of perjury, I declare that I have examined this entire application and to the best of my knowledge, all of the information is
true, accurate, and complete. I also certify that the scholarship organization:
(a) is a charitable organization in the State of Rhode Island that is exempt from federal taxation under section 501(c)(3) of the internal
revenue code;
(b) allocates at least ninety percent (90%) of its annual revenue through a scholarship program for tuition assistance grants to eligible
students to allow them to attend any qualified school of their parents’ choice represented by the scholarship organization;
(c) has a scholarship program that provides tuition assistance grants to eligible students to attend a nonpublic school located in this
state; and
(d) awards scholarships to eligible students without limiting availability to only students of one school.
Signature Title Date
Please Print Name NOTE:SEE PAGE 2 FOR ADDITIONAL INFORMATION
AND REQUIREMENTS
Pursuant to RIGL 44-62-2 Qualification of scholarship organization - a scholarship organization must certify annually by December 31st to
the Division of Taxation that the organization is eligible to participate in the program in the subsequent year in accordance with the above
criteria.
Mail completed application to RI Division of Taxation - One Capitol Hill - Providence, RI 02908 - Attn: Donna Dube
