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FEIN: __ __ - __ __ __ __ __ __ __ Fiscal Year End: _____/______/_________ Certificate no. _______________
MM
DD
YYYY
(if applicable)
Full name of organization: ______________________________________________________________________
Principal address of organization:
Phone number: _________________________________
__________________________________________
Contact person: _________________________________
__________________________________________
Contact’s email: ________________________________
__________________________________________
Website: ______________________________________
Check if this is name or address change and give previous name or address:
________________________________________________________________________________________
________________________________________________________________________________________
An exemption/exclusion request that is not accompanied by all required documentation as listed below will
not be considered. Do not request exemptions/exclusions that cannot be supported by documentation. An
exemption/exclusion request has not been approved unless the organization receives a letter confirming the
exemption/exclusion.
The organization is exempt from the registration requirements of the Solicitation of Funds for Charitable
Purposes Act under 10 P.S. § 162.6 (relating to Exemptions from registration) or excluded from the Act under 10
P.S. § 162.3 (definition of charitable organization) or otherwise not required to register as a charitable
organization under the Act for the following reasons (check as many as apply):
Exemption claimed
Required documentation
Educational institution or any
auxiliary association, foundation or
support group which is directly
responsible to an educational
institution
§ 162.6(a)(1)
• Articles of incorporation/charter
• Bylaws
• Proof that the curricula of the educational institution is
registered with, or approved by, the Pennsylvania
Department of Education, either directly