Wyoming Department of Education
Section 25F Scholarship Granting Organization (SGO)Application & Annual Certification Form
Program Overview & Authority
This application is for non-profit entities seeking certification and inclusion on the official Wyoming State SGO List, administered by the Wyoming Department of Education. Inclusion on the State SGO List is governed pursuant to Internal Revenue Code Section 25F, Treasury Decision 10057 (Temporary Regulation § 1.25F-1T through § 1.25F-5T), and Notice of Proposed Rulemaking REG-117199-25 (Proposed Regulation § 1.25F-1 through § 1.25F-5).
Section 1: SGO General Information
SGO General Information
Rows
Organization Entry
Legal Name of Organization
Employer Identification Number (EIN)
Physical Address (Wyoming Location)
Mailing Address (if different)
Primary Contact Person
First Name
Last Name
Contact Title
Direct Phone
Format: (000) 000-0000.
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Organization Entry
Contact Email Address
Organization Website URL
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Section 2: Operational Status & Structure
Operating Classification
Single-State SGO: Operations and scholarship granting are strictly restricted to the State of Wyoming.
Multistate SGO: Operations span multiple states with dedicated accounting for Wyoming funds.
Operational History & Documentation
Established SGO: Attach historical operational data, financial records, and previous audit reports. Attachment: File
Newly Established SGO (New SGO Transition Rule): Lacking historical operational data; certification relies on governing documents, bylaws, and written policies confirming the entity's ability and intent to comply with operational rules. Attachment: File
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Section 3: Tax-Exempt Status & State Authorization
IRS Section 501(c)(3) Status
Active 501(c)(3) Public Charity
Other
Pending 501(c)(3) Application
Other
Wyoming State Business Authorization
Certified Wyoming Entity
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Section 4: Account & Financial Integrity
Segregated Account Certification
Dedicated Section 25F Account
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Section 5: Operational Rules Compliance Certifications
By checking each required box below, the authorized officer certifies that the organization strictly complies with all operational mandates under Section 25F(c)(5) and (d):
Student Capacity
Minimum Expenditure
Priority Distribution
Income Eligibility Verification
Residency Requirement
Self-Dealing Prohibition
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Section 6: Audit & Reporting Commitments
Confirm all that apply.
Annual Audit Submission
Compliance Failure & Corrective Action
Notice of Material Changes
Prompt Removal & Due Process
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Section 7: Authorization & Attestation
"I hereby certify under penalty of perjury that the information provided in this application is true, correct, and complete, and that the organization complies with all applicable federal and state Section 25F statutory and regulatory requirements."
Authorized Representative Signature
Printed Representative Name
First Name
Last Name
Official Title
Date of Execution
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Month
-
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Primary Organizational Document Attachment
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