Fillable Form Ed-05 - Scholarship Organization Report

New Hampshire

2015

Department of

ED-05

Revenue Administration

FOR DRA USE ONLY

SCHOLARSHIP ORGANIZATION REPORT

PRINT OR TYPE

STEP 1

SCHOLARSHIP ORGANIZATION:

STREET ADDRESS:

ADDRESS (CONTINUED):

CITY/STATE/ZIP:

This Scholarship Organization Report has been developed by the Department of Revenue Administration for

submission by a scholarship organization to the Department of Revenue Administration and shall be a public record,

pursuant to RSA 77-G:1, XIX.

On or prior to December 1, 2015, the scholarship organization shall submit a Scholarship Organization Report to the

Department of Revenue Administration. The scholarship organization shall also include a Scholarship Organization

Application if the scholarship organization intends to issue scholarships under RSA 77-G in the next program year.

Under RSA 77-G the following data must be provided by each scholarship organization:

STEP 2

The number of scholarships granted to eligible students who are New Hampshire residents and who are at least 5

years of age and no more than 20 years of age, have not graduated from high school, and who are currently attending

a New Hampshire public school, including a chartered public school, for whom the adequacy grant in the next school

year would be reduced if the student(s) were removed from the average daily membership calculation and whose

annual household income is less than or equal to 300 percent of the federal poverty guidelines as updated annually in

the Federal Register by the United States Department of Health and Human Services under the authority of 42 U.S.C.

section 9902(2).

1(a) Number of students .........................................

The percentage of these students who were eligible for the federal free and reduced-price meal program in the final

year they were in public school.

1(b) Percentage of students eligible........................

The number of scholarships granted to eligible students who are New Hampshire residents and who are at least 5

years of age and no more than 20 years of age, have not graduated from high school, and who received a scholarship

under the above paragraph or this subparagraph in the prior program year and whose annual household income is

less than or equal to 300 percent of the federal poverty guidelines as updated annually in the Federal Register by the

United States Department of Health and Human Services under the authority of 42 U.S.C. section 9902(2).

2(a) Number of students ...........................................

The percentage of these students who were eligible for the federal free and reduced-price meal program in the final

year they were in public school.

2(b) Percentage of students eligible...........................

ED-05

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Rev 1 10/2014

Form Ed-05 - Scholarship Organization Report - 2015