Form 5578 - Annual Certification Of Racial Nondiscrimination For A Private School Exempt From Federal Income Tax

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5578

OMB No. 1545-0213

Annual Certification of Racial Nondiscrimination

Form

Open to Public

for a Private School Exempt From Federal Income Tax

(Rev. April 2009)

Inspection

Department of the Treasury

(For use by organizations that do not file Form 990 or Form 990-EZ)

For IRS Use Only

Internal Revenue Service

For the period beginning

and ending

Name of organization that operates, supervises, and/or controls school(s).

Employer identification number

Address (number and street or P.O. box no., if mail is not delivered to street address)

Room/suite

City or town, state, and ZIP + 4 (If foreign address, list city or town, state or province, and country. Include postal code.)

Name of central organization holding group exemption letter covering the school(s). (If same as 1a above, write

Employer identification number

“Same” and complete 2c.) If the organization in 1a above holds an individual exemption letter, write “Not Applicable.”

Address (number and street or P.O. box no., if mail is not delivered to street address)

Room/suite

Group exemption number (see

instructions under Definitions)

City or town, state, and ZIP + 4 (If foreign address, list city or town, state or province, and country. Include postal code.)

Name of school. (If more than one school, write “See Attached,” and attach a list of the names, complete addresses,

Employer identification number,

including postal codes, and employer identification numbers of the schools.) If same as 1a above, write “Same.”

if any

Address (number and street or P.O. box no., if mail is not delivered to street address)

Room/suite

City or town, state, and ZIP + 4 (If foreign address, list city or town, state or province, and country. Include postal code.)

Under penalties of perjury, I hereby certify that I am authorized to take official action on behalf of the above school(s) and that to the best of my knowledge and belief

the school(s) has (have) satisfied the applicable requirements of sections 4.01 through 4.05 of Rev. Proc. 75-50, 1975-2 C.B. 587, for the period covered by this

certification.

(Signature)

(Type or print name and title.)

(Date)

General Instructions

An authorized official of a central

secondary, preparatory, or high schools

organization may file one form to certify for

and colleges and universities, whether

the school activities of subordinate

operated as a separate legal entity or as

Section references are to the Internal Revenue

organizations that would otherwise be

an activity of a church or other

Code unless otherwise noted.

required to file on an individual basis, but

organization described in section 501(c)(3).

Note. This form is open to public

only if the central organization has enough

The term also includes preschools and any

inspection.

control over the schools listed on the form

other organization that is a school as

to ensure that the schools maintain a

defined in section 170(b)(1)(A)(ii).

Purpose of Form

racially nondiscriminatory policy as to

A central organization is an organization

Form 5578 may be used by organizations

students.

that has one or more subordinates under

that operate tax-exempt private schools to

its general supervision or control. A

Definitions

provide the Internal Revenue Service with

subordinate is a chapter, local, post, or

the annual certification of racial

A racially nondiscriminatory policy as to

other unit of a central organization. A

nondiscrimination required by Rev. Proc.

students means that the school admits the

central organization may also be a

75-50 (the relevant part of which is

students of any race to all the rights,

subordinate, as in the case of a state

reproduced in these instructions).

privileges, programs, and activities

organization that has subordinate units and

generally accorded or made available to

is itself affiliated with a national

Who Must File

students at that school and that the school

organization.

does not discriminate on the basis of race

Every organization that claims exemption

The group exemption number (GEN) is a

in the administration of its educational

from federal income tax under section

four-digit number issued to a central

policies, admissions policies, scholarship

501(c)(3) of the Internal Revenue Code and

organization by the IRS. It identifies a

and loan programs, and other

that operate(s), supervises, or controls a

central organization that has received a

school-administered programs.

private school(s) must file a certification of

ruling from the IRS recognizing on a group

racial nondiscrimination. If an organization

The IRS considers discrimination on the

basis the exemption from federal income

is required to file Form 990, Return of

basis of race to include discrimination on

tax of the central organization and its

Organization Exempt From Income Tax, or

the basis of color or national or ethnic

covered subordinates.

Form 990-EZ, Short Form Return of

origin.

Organization Exempt From Income Tax,

When To File

A school is an educational organization

either as a separate return or as part of a

that normally maintains a regular faculty

Under Rev. Proc. 75-50, a certification of

group return, the certification must be

and curriculum and normally has a

racial nondiscrimination must be filed

made on Schedule E (Form 990

regularly enrolled body of pupils or

annually by the 15th day of the 5th month

or 990-EZ), Schools, rather than on this

following the end of the organization’s

students in attendance at the place where

form.

its educational activities are regularly

calendar year or fiscal period.

carried on. The term includes primary,

5578

For Paperwork Reduction Act Notice, see page 3.

Cat. No. 42658A

Form

(Rev. 4-2009)

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