South Carolina Students with Disabilities Tuition Tax Credit Verification

Students with Disabilities Tuition Tax Credit Verification
CHE400_9105.pdf
STATE OF SOUTH CAROLINA

1350

DEPARTMENT OF REVENUE

dor.sc.gov

STUDENTS WITH DISABILITIES
TUITION TAX CREDIT VERIFICATION

CHE-400

(Rev. 7/21/20)
9105

Tax year:
Part I: Taxpayer Information
SSN:

Name:
Address:
City:

State:

ZIP:

Phone:

Part II: Student Information
SSN:

Name:
Address:
State:

City:

ZIP:

Phone:

South Carolina institution of attendance:
Part III: Authorized disability services provider verification
The disability services provider at the institution of attendance must complete this section.
If the student attended more than one institution in the tax year:
• A verification form must be completed for each institution attended.
• The verification form must be verified by the disability services provider at each institution attended.
Title:

Name:
Institution:
Name of office or department:

I verify that ______________________ was certified under the Americans with Disabilities Act and Section 504 of the
Rehabilitation Act of 1973 as a student with a disability prior to each semester of enrollment. I have determined this
student was unable to successfully complete 30 credit hours, or credit hour equivalents, this year. As a result,
______________________ was approved to enroll in fewer than 30 credit hours, or credit hour equivalents, during the
Spring, Summer, and Fall semesters.

Disability services provider signature

Date

Part IV: Student and taxpayer verification
I certify that the eligibility requirements for the Tuition Tax Credit are met in accordance with Section 2, Article 25, Chapter
6, Title 12 of the 1976 Code. I certify that the above disability services provider has determined the credit hour
requirement should be reduced as a result of a documented and verified disability.
Student signature

Date

Parent or legal guardian signature

Date

If you file by paper, attach this form to your I-319, Tuition Tax Credit, and submit to the SCDOR along with your SC1040,
Individual Income Tax Return. If you file electronically, keep a copy with your tax records.

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