Certificate Of Eligibility To Transfer Template
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1Scholarship Foundation
WE MAKE
ACADEMIC ACHIEVEMENT ACCESSIBLE
Certificate of Eligibility to Transfer
(If you have more than one student, please copy & submit one for each student)
Date:
/
/
This certifies that the student listed below was a recipient of a Tax Credit Scholarship
from
during all or part of the 2015-2016 school year:
(Name of organization which awarded the previous scholarship)
STudeNT NAMe
AWARd AMOuNT uP TO:
Amount as of:
/
/
$
$
*This information must be completed by the Scholarship Organization from which the student received a Tax Credit Scholarship.*
Print Name & Title:
(Name & title of the representative from the organization)
Signature:
(Signature of the representative from the organization)
This form is required if student is transferring from another Tax Credit Scholarship Program and must
be provided to the processing center in order to complete your application.
Also send a copy of the completed form to:
PSAS, P.O. BOX 89434, CLeVeLANd, OH 44101-6434
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