Form Ed-05 - Scholarship Organization Report - 2015 Page 2
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4New Hampshire
2015
Department of
ED-05
Revenue Administration
SCHOLARSHIP ORGANIZATION REPORT (continued)
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 do not qualify under
the above paragraphs (1) or (2); 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).
3(a) Number of students .........................................
The percentage of these students who were eligible for the federal free and reduced-price meal program in the prior
year.
3(b) Percentage of students eligible...........................
$
4(a) The total dollar amount of donations received ........................................................
4(b) The total dollar amount of donations used for scholarships ....................................
$
4(c) The total dollar amount of donations spent on administrative expenses pursuant to
$
RSA 77-G:5, I(f) ......................................................................................................
$
4(d) The total dollar amount of donation not used for scholarships .................................
5.
The total dollar amount of all scholarships granted ..................................................
$
6.
The number of scholarships granted ........................................................................
7.
The number of scholarships distributed by the organization, per school, and the dollar range of those scholarships.
(All home educated students shall be totaled together as a single school.) If more than one school, attach additional
pages.
(a) Number of Scholarships.....................................
(b) Dollar range of Scholarships .............................
to
8.
List number of students receiving a scholarship under RSA 77-G by zip code:
Number of Students
Zip Code
Number of Students
Zip Code
9.
(1) The aggregated results from the NH Education Tax Credit Survey designed by the Department of Revenue
Administration under RSA 77-G:1, XIX (k).
(a)
Number of participating students ........................................................................
(b)
Number of participating students whose parents/legal guardians responded ....
(c)
Percentage of participating students whose parents/legal guardians responded
ED-05
Rev 1 10/2014
Page 2 of 4
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