SCHOLARSHIP ACKNOWLEDGMENT AND CERTIFICATION

The undersigned parent or legal guardian of the student listed below or identified in communications accompanying this form (the “Eligible Student) hereby:

• Certifies to Opportunity Scholarships of Nebraska (“OSN”) that he or she is the parent or legal guardian of the Eligible Student, and that the Eligible Student is a resident of Nebraska.

• Acknowledges that the Eligible Student has received a scholarship (an “Opportunity Scholarship”) pursuant to 2023 Neb. Laws L.B. 753 (the “Opportunity Scholarships Act”).

• Certifies to OSN that the Eligible Student is or will be enrolled in the qualified school (as defined by the Opportunity Scholarships Act) previously identified to OSN and chosen by the undersigned on behalf of the Eligible Student (the “Qualified School”). 

• Certifies to OSN that the Eligible Student meets at least one of the following criteria (a)-(c): the Eligible Student (a) is receiving an Opportunity Scholarship for the first time and is either: (i) entering kindergarten or ninth grade in THE Qualified School, or (ii) transferring from a public school at which the student was enrolled for at least one semester immediately preceding the first semester for which the student receives an Opportunity Scholarship, to theQualified School and is entering any of grades kindergarten through twelve; (b) has previously received an Opportunity Scholarship and is continuing education at the Qualified School until the Eligible Student graduates from high school or reaches 21 years of age, whichever comes first; or (c) is the sibling of a student who is receiving an Opportunity Scholarship, resides in the same household as such student, and is enrolling in or continuing education at theQualified School.

• Agrees on behalf of the Eligible Student to have OSN pay their Eligible Student’s scholarship to the Qualified School, for the purpose of paying costs permitted by applicable law.

With your electronic signature, you certify, acknowledge and agree to the above.