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AZ State Tax Credit Donation Form

Kaleidoscope School

16850 N. 16th St. Phoenix, Az 85022

Tax ID: 20-1431933 CTDS #: 078616001

Please complete the form below. Required fields marked with an asterisk *

Contact Information

First Name*

Answer Required

Last Name

Answer Required

Email 1*

Answer Required

Mobile Phone*

Number Required

Address

Street Address

Answer Required

City

Answer Required

Zip/Postal

Answer Required

Amount of Contribution*

Answer Required

$200.00 - Individual

$400.00 - Married, filing jointly

Other:

Donating on behalf of (Student Name)*

Answer Required

Please put my money towards*

Answer Required

General Fund

Playground Equipment

School Meal Programs

Student Healthcare Supplies

Pupil/Non Pupil Transportation

Textbooks, Instructional Aides, Library Books

Confirmation Email

Confirmation Email *

Email Required