1. Cover Letter

2016 TAX INFORMATION PACKET SMALL PARISH PAYROLL

TABLE OF CONTENTS

2. Form 1099-MISC Instructions

3. Determining Independent Contractor vs. Employee document

4. Example Form 1099-MISC

5. Form 1096 Instructions

6. Example Form 1096

7. Information and Instruction on the Illinois Department of Revenue Education Expense Credit

8. Blank Forms for Parish use: 1099-MISC, 1096 Can be requested from Dara Bose or Chrissy Maher by calling the Diocese at (217) 698-8500.

Diocese of Springfield in Illinois Catholic Pastoral CE'nler • 1615 Wesl Washinglon • Springfield, Illinois 62702-4757

www.dio.org (217) 698-8500 Fax: (217) 698-0802

Office for Finances

November 29, 2016

Dear Fathers, Sisters, and Administrators:

We are providing the enclosed information as an aid to help you complete the year-end tax reporting for all priests, employees and independent contractors. Fortunately, since your parish is on the "Small Parish Payroll" Paychex system, most of the year-end reporting is completed by Paychex and by the Diocese.

The enclosed materials will assist you in completing Forms 1099 and 1096 for any independent contractors you may have. Additionally, the IRS website contains an abundance of information (https://www.irs.gov(forms-pubs). Especially useful is the Employer's Tax Guide, Publication 15, Circular E (https://www.irs.gov/publirs­pdf/pl 5.pdj).

Please contact Dara Bose, Chrissy Maher, or me if you have any questions .

Sincerely yours in Christ,

John J. Maxwell, Director Department for Financial Services

TAX INSTRUCTIONS: FORM 1099-MISC

Form 1099-MISC must be issued when a parish pays at least $600.00 a year for personal services or contractual services from any individual who is not a corporate entity. Use Form 1099-MISC for items such as independent contract work, contracted janitorial, waste removal, snow removal and lawn care. Form 1099-MISC is due to the recipient by February 1, 2016.

Form 1099-MISC Submission

Copy A - Due to the Internal Revenue Service by January 31, 2017.

All Copy A forms are attached to Form 1096 and mailed to: Department of the Treasury Internal Revenue Service Center Kansas City, Missouri, 64999

Copy 1 - Due to the State Tax Department (Not Required in Illinois).

Copy B - Due to Recipient by January 31, 2017.

Copy 2 -To be filed with Recipient's State Income Tax Return, where required.

Copy C - Payer's (Parish) copy.

Form 1099-MISC Instructions

1. Enter the Parish name, address, city, state, zip code, and telephone number.

2. Enter the Parish's Federal Identification Number (xx-xxxxxxx).

3. Enter the Recipient's Social Security Number or Tax Identification Number.

4. Enter the Recipient's name, address, city, state and zip code.

5. Box 7 - Nonemployee Compensation. Enter the compensation amount. This includes payments, fees, bonuses, and other forms of compensation for services provided by the individual who is not an employee.

Determining Independent Contractor vs. Employee

XVIII. Personnel

A. Independent contractor vs. employee No one person should be classified and compensated as both an independent contractor and an employee.

An independent contractor is defined as an individual who follows an independent trade, business, or profession in which services are offered to the general public. The employer has the right to control only the result of the work; not the means and method of accomplishing the result.

An employee is defined as an individual who is employed by another usually for wages or salary. The employee receives benefits from the employer and is provided training on the required methods and procedures to complete the work. The employer has the right to control when and how work will be done.

Determination of whether or not an individual is classified as an employee or independent contractor is critical to ensuring appropriate compensation and avoidance of penalties imposed by IRS and state agencies. The status of an employee determines employer obligations under federal and state laws. These same laws do not apply to an independent contractor. The consequences for an employer of misclassifying an employee as an independent contractor can bring significant tax, wage and benefits liabilities, as well as massive fines that may be imposed by the IRS. The question of which category an employee fits is fundamental, yet even the courts have struggled with its determination. However, the responsibility for making the correct decision rests completely with the employer.

In order to assist the parish in the determination of the proper status of an employee the following discussion and presentation of criteria used by Federal courts provides guidance:

IRS Independent Contractor Test

The IRS formerly used what has become known as the "Twenty Factor" test. Under pressure from Congress and from representatives oflabor and business, it has recently attempted to simplify and refine the test, consolidating the twenty factors into eleven main tests, and organizing them into three main groups: behavioral control, financial control, and the type of relationship of the parties. Those factors appear below, along with comments regarding each one.

Behavioral control

Facts that show whether the business has a right to direct and control how the worker does the task for which the worker is hired include the type and degree of-

• Instructions the business gives the worker. An employee is generally subject to the business' instructions about when, where, and how to work. All of the following are examples of types of instructions about how to do work:

o When and where to do the work

o What tools or equipment to use

o What workers to hire or to assist with the work

o Where to purchase supplies and services

o What work must be performed by a specified individual

o What order or sequence to follow

The amount of instruction needed varies among different jobs. Even if no instructions are given, sufficient behavioral control may exist if the employer has the right to control how the work results are achieved. A business may lack the knowledge to instruct some highly specialized professionals; in other cases, the task may require little or no instruction. The key consideration is whether the business has retained the right to control the details of a worker's performance or instead has given up that right.

• Training the business gives the worker. An employee may be trained to perform services in a particular manner. Independent contractors ordinarily use their own methods.

Financial control

Facts that show whether the business has a right to control the business aspects of the worker's job include:

• The extent to which the worker has unreimbursed business expenses. Independent contractors are more likely to have unreimbursed expenses than are employees. Fixed ongoing costs that are incurred regardless of whether work is currently being performed are especially important. However, employees may also incur unreimbursed expenses in connection with the services they perform for their business.

• The extent of the worker's investment. An employee usually has no investment in the work other than his or her own time. An independent contractor often has a significant investment in the facilities he or she uses in performing services for someone else. However, a significant investment is not necessary for independent contractor status.

• The extent to which the worker makes services available to the relevant market. An independent contractor is generally free to seek out business opportunities. Independent contractors often advertise, maintain a visible business location, and are available to work in the relevant market.

• How the business pays the worker. An employee is generally guaranteed a regular wage amount for an hourly, weekly, or other period of time. This usually indicates that a worker is an employee, even when the wage or salary is supplemented by a commission. An independent contractor is usually paid by a flat fee for the job. However, it is common in some professions, such as law, to pay independent contractors hourly.

• The extent to which the worker can realize a profit or loss. Since an employer usually provides employees a workplace, tools, materials, equipment, and supplies needed for the work, and generally pays the costs of doing business, employees do not have an opportunity to make a profit or loss. An independent contractor can make a profit or loss.

Type of relationship

Facts that show the parties' type of relationship include:

• Written contracts describing the relationship the parties intended to create. This is probably the least important of the criteria, since what really matters is the nature of the underlying work relationship, not what the parties choose to call it. However, in close cases, the written contract can make a difference.

• Whether the business provides the worker with employee-type benefits, such as insurance, a pension plan, vacation pay, or sick pay. The power to grant benefits carries with it the power to take them away, which is a power generally exercised by employers over employees. A true independent contractor will finance his or her own benefits out of the overall profits of the enterprise.

• The permanency of the relationship. If the company engages a worker with the expectation that the relationship will continue indefinitely, rather than for a specific project or period, this is generally considered evidence that the intent was to create an employer-employee relationship.

• The extent to which services performed by the worker are a key aspect of the regular business of the company. If a worker provides services that are a key aspect of the company's regular business activity, it is more likely that the company will have the right to direct and control his or her activities. For example, if a law firm hires an attorney, it is likely that it will present the attorney's work as its own and would have the right to control or direct that work. This would indicate an employer-employee relationship.

Employers must be vigilant about worker status when filling staffing needs. Employers, Pastors and parish administrators are encouraged to thoughtfully apply the above criteria in making a final determination of a worker's status. If needed, contact the Human Resources Department of the Diocese at 217.698.8500 for additional assistance.

Source: Parish Guidelines & Procedures Version 3 (10.21.09)

9595 nvrno n CORRECTED PAYER'S name, s1reet address, city°' town, state°' province, country. ZIP or foreion postal code, and telephone oo.

1 Aeots 0MB No. 1545-0115

Blessed Trinity Parish $ ~@ 16 Miscellaneous 1000 Parish Lane 2Aoyalties Income Scranton, IL 62345

$ Form 1099-MISC 3 Othe< income 4 Federal income tax withheld Copy A $ $ For

PAYER'S federal identification number RECIPIENT'S identifica!ion nurrbef 5 Fishing boat proceeds 8 Medea! and heol!h care payments Internal Revenue Service Center

37-1231234 122-25-2525 $ $ File with Form 1096. RECIPIENT'S name 7 N~loyee compensation 8 Substitute payments ii lieu o For Privacy Act

Olaf's Snow Removal dividends or interes1 and Paperwork Reduction Act

Street address (Including apt. oo.) $ 1500.00 $ Notice, see the 1225 Arendelle Way 9 P3yer made dr ect sales of 10 Crop insurance proceeds 2016 General

$5,000 or more of consumer Instructions for products to a buyer Certain Ci!y or town. state or province. coll'ltry. and ZIP or foreign postal code (recipient) for resale • D $

11 12 Information Arendelle, IL 62378 Returns.

Accouot number (see instructions) FATCAfiling 2nd TIN not. 13 Excess golden parachute 14 Gross proceeds paid to an requirement D payments attomey

D $ $ 15a Section 409A deferrals 15b Section 409A iicome 16 State tax w~hheld 17 State/PayC1"'s state no. 18 St<1te income

$ $ $ $

------------ --- ------ ------------ ------- ---$ $ Form 1099-MISC C3t. No. 14425J www.irn.gov/form1099misc Oepa,tment of the Tre3SlJrY - lntemol Aelli!tlue SC1"vice Do Not Cut or Separate Forms on This Page - Do Not Cut or Separate Forms on This Page

TAX INSTRUCTIONS: FORM 1096

Annual Summary and Transmittal of U.S. Information Returns

Form 1096 Submission Form 1096, attached to all of the 1099-MISC Copy A forms, are due to the Internal Revenue Service by February 28, 2017:

Department of the Treasury Internal Revenue Service Center Kansas City, MO, 64999

Form 1096 Instructions Complete the Filer contact information. In the appropriate boxes, enter the Parish name and address, contact person, Parish phone number, fax number and e-mail address. The contact person should be the individual signing the return and who will answer questions about the form.

Box 1 - Employer Federal Identification Number.

Box 2 - Leave blank.

Box 3 - Enter total number of individual 1099-MISC forms that are attached.

Box 4 - Enter total amount of taxes withheld on the 1099s attached (normally zero).

Box 5 - Enter total amounts from all 1099-MISCs being transmitted.

Box 6 - Enter an "X" in box1099-M1SC (#95).

Form 1096 should be signed and dated with title of the individual signing the return.

Do Not St.pie b969 0MB No. 1545-0108

Fom, 1096 Annual Summary and Transmittal of ~@16 Department of the Treasury U.S. Information Returns

Internal Revenue Se,v,ce

FILER'S name

Blessed Trinity Parish

Street address (including room or suite number)

1000 Parish Lane

City or town, slate or province. count,y. and ZIP or foreign postal code

Scranton, IL 62345 Name of per-..on to contact Telephone nurrber For Offic ial Use Only

Dwight Schrutte (217) 280-9797 a I I I I I I I rn Email address Fa>< number dwight@pari sh.org (217) 280-9292

1 Employer identification numberl 2 Social security nurrbef 3 Total number of forms 4 Federal income tax wtlhheld I Ii Total amount reported wi1h this Form 1096 37-1231234 123-45-6789 2 $ $ 2250.00

6 Enter an •x• in onh one box below to indicate the 1v1 "of form beino filed. 7 Form 1099-MISC with NEC in box 7. check .... o W-2G 1007-BTC 10!l8 1098-C 10118-E IO!IB-0 10!l8-T 1099-A 1099-B 10ll9-C 1099-CAP 101111-DIV 1099-G 1099~ITT 1099-K

32 50 81 78 1W 7• 83 80 79 85 73 QI 86 92 10

D D D D D D D D D D D D ~ D D 10911-LTC 1099-MISC 1009-0ID 1099-PATA 1099-0 ,~ 1099-R 1099-S 1099-SA 3921 3922 5496 5496-ESA 5498.QA 5498-SA

93 95 B6 97 31 1A 98 75 1M 25 2G 28 72 2A 21

D D D D D D D D D D D D D D D Return this entire page to the Internal Revenue Service. Photocopies are not acceptable.

Under pen.ilties of perjuiy, I declare that I have examined this rerun and acco"1)al1Ying docLITlfflls, and, to the best of my knowledge and belief, they are true. correct. and COITl)lete.

Signature..,

Instructions Future developments. For the latest information about developments related to Form 1096, such as legislation enacted after it was published, go to www.irs.gov/form1096. Reminder. The only acceptable method of filing the information retirns listed on this form in box 6 electronically with the Internal Revenue Service is through the FIRE system. See Pub. 1220.

Purpose of fonn. Use this form to transmit paper Fonns 1097, 1098, 1099, 3921, 3922, 5498, and W-2G to the Internal Revenue Service.

Caution: If you are required to file 250 or more information returns of any one type, you must file electronically. If you are required to file electronically but fail to do so, and you do not have an approved waiver, you may be subject to a penalty. For more information, see part F in the 2016 General Instructions for Certain Information Rett.mS.

Forms 1099-QA and 5498-QA can be filed on paper only, regardless of the number of returns. Who must file. The name, address, and TIN of the filer on this form must be the same as those you enter in the upper left area of Forms 1097, 1098, 1099, 3921, 3922, 5498, or W-2G. A filer is any person or entity who files any of the forms shown in line 6 above.

Enter the filer's name, address (including room, suite, or other unit number), and TIN in the spaces provided on the form.

D ... 1/3/:20:1.,7' ate

When to file. File Form 1096 as follows. • Wrth Forms 1097, 1098, 1099, 3921, 3922, orW-2G, file by February 28, 2017.

Caution: File Form 1099-MISC by January 31, 2017, if you are reporting nonemployee compensation in box 7. Also, check box 7 above. • Wrth Forms 5498, file by May 31 , 2017.

Where To File Send all information reluns filed on paper with Form 1096 to the foAowing.

If your principal business, office or agency, or legal residence in

the case of an individual, is located in

---Alabama, Arizona, Mansas, Connecticut. Delaware, Florida, Georgia, Kentucky, Louisiana, Maine, Massachusett:,. Mississippi. New Han1)Shire. New Jersey, New Mexico, New York. North Carolina, Ohio, Pennsylv311ia, Rhode Island, Texas, Vermont, Vitgi,ia, West Virgiiia

Use the following three-line address

Department of the Treaswy Internal Revenue Service Center

Austin, TX 73301

For more infonnation and the Privacy Act and Paperwork Reduction Act Notice, see the 2016 General Instructions for Certain Information Returns.

Cal No. 144000 Form 1096 (2016)

Diocese of Springfield in Illinois Catholic Pasloral Center • 1615 Wes t Washington • Springfield, Illinois 62702-4757

www.dio.org (217) 698-8500 Fax: (217) 698-0802

Office for Finances

TO: All Pastors, Church and School Administrators, Parish Administrators, and Bookkeepers

FROM: John J. Maxwell, Director of the Department for Financial Services

DATE: November 29, 2016

SUBJECT: Illinois Department of Revenue Education Expense Credit

Effective January 1, 2000, any Illinois resident who is a parent or legal guardian of a student in an Illinois elementary or secondary school is eligible to take tax credit on their individual income tax return. Any amounts for tuition, book fees and lab fees in excess of $250.00 are eligible for this tax credit. The deduction is 25% of expenses in excess of $250.00 limited to $500.00 per family.

Most of you will probably be receiving inquiries from parents of your students about this credit. In order for parents to claim this credit, they will need either a receipt from the school or complete Illinois schedule ED. While schools are not required to provide written receipts, they are encouraged to issue one to each family who has had students attending during the calendar year. Many of you can limit the phone calls from parents by issuing a receipt. A sample form is enclosed. The only items on this form you may have trouble providing are the parents' or guardians' and students' Social Security Numbers. My advice would be to complete the form without the number and let the parent or guardian add the Social Security Information. Also, tuition is the amounts billed and paid to the school; free will offerings or donations to the church and school are not eligible for this credit.

Enclosed, please find two Illinois Department of Revenue Information Bulletins. One is for the school and the other is for the taxpayer. Each provides forms and examples.

Publication 112 February 2015

Education Expense Credit General Rules and Requirements for Schools

The information in this publication

is current as of the date of the About this publication

publication. Please visit our website at Publication 112, Education Expense Credit General Rules and Requirements for tax.illinois.gov to verify you have the Schools, provides all Illinois public and nonpublic schools the requirements for written most current revision. receipts for qualified education expenses. The objectives of Publication 112 are to

This publication is written in the plain • identify qualified education expenses. English style so the tax information is

easier to understand. As a result, we • identify Illinois schools. do not directly quote Illinois statutes

or the Illinois Administrative Code. • list requirements for written receipts. The contents of this publication are

informational only and do not take • provide a sample of a written receipt.

the place of statutes, rules, or court

decisions. For many topics covered

in this publication, we have provided

a reference to the applicable section

or part of the Illinois Administrative

Code for further clarification or more

detail. All of the sections and parts

referenced can be found in Title 86 of

the Illinois Administrative Code.

Taxpayer Bill of Rights

You have the right to call the Department of Revenue for help in resolving tax problems.

You have the right to privacy and confidentiality under most tax laws.

You have the right to respond, within specified time periods, to Department notices by asking questions, paying the amount due, or providing proof to refute the Department's findings.

You have the right to appeal Department decisions, in many instances, within specified time periods, by asking for Department review or by taking the issue to court.

If you have overpaid your taxes, you have the right, within specified time periods, to a credit (or, in some cases, a refund) of that overpayment.

For more information about these rights and other Department procedures, you may write us at the following address:

Problems Resolution Office Illinois Department of Revenue PO Box 19014 Springfield, IL 62794-9014

i

Get forms and other information faster and easier at tax.illinois.gov

Contents Education Expense Credit General Rules and Requirements for Schools I

General Information

What are qualified education expenses? ........... ... .. ........................ ............ ....... ...... ..... .. .... .... 2 What schools qualify as Illinois schools? .................... ..... ...... ..... ......... ... ......... .. .... ................. 2 Are Illinois schools required to provide a written receipt for education expenses? ..... .. ....... ... 2

Sample Written Receipt ...... ... ... ...... ........ ...... ..... ......... .... .. ..... .... ..... .. .... ....... ...... ........ 3

Office Locations .... .................... ... .......... ............ ......... ................ ....... ....... ............... . 4

For information or Forms .... ... .. ........ .... ............................... ........... .. ... ..... ....... .. ... .... 4

General Information ---------------·-------·-- - - - ---·-··-------- -- ··--- --------

What are qualified education expenses? In general, qualified education expenses are the amounts paid in excess of $250 for tuition , book fees, and lab fees at the school where the student is enrolled during the regular school year.

Specifically, qualified education expenses include the amount of

• tuition paid for a student who was enrolled in kindergarten through twelfth grade.

Note: This does not include summer school enrichment classes.

• book fees paid for the rental of books that were required as part of the student's participation in the school's education program.

Note: This does not include books purchased by the student.

• lab fees paid for the use of supplies, equipment, materials, or instruments that were required as part of the student's participation in a lab course in the school's education program.

Lab courses include those courses, for which the student will receive credit toward graduation, that provide an environment for organized activity involving observation , experimentation, or practice, (i.e., science, music, art, or language).

Note: Only musical instruments rented from the school (not from a business) qualify as an education expense.

Any purchased equipment, materials, or instruments that are substantially consumed (i.e. , it essentially has no remaining value) by the assignments and activities of the lab are considered qualified lab fees.

Any amount paid for the purchase of an item that will remain the personal property of the student, parent, or legal guardian at the end of the school year, is not considered a qualified education expense (e.g., payments made toward the purchase of a band instrument or athletic equipment).

What schools qualify as Illinois schools? For the purpose of the education expense credit, public or nonpublic elementary or secondary schools in Illinois that satisfy

Page 2 of 4

the requirements of the truancy law in Section 26-1 of the School Code and, if required, are in compliance with Title VI of the Civil Rights Act of 1964 qualify as Illinois schools.

Private schools providing educational instruction in the home that satisfy the requirements of the truancy law in Section 26-1 of the School Code also qualify as Illinois schools.

Are Illinois schools required to provide a written receipt for education expenses? Illinois schools are encouraged to provide a written receipt for education expenses paid at the school for the qualifying student(s) during the calendar year. The school should provide this receipt on or before January 31 of the following calendar year.

When a school provides a written receipt, the written receipt must be in the format prescribed by the Illinois Department of Revenue. An example of the receipt is shown on Page 3.

The written receipt must include the

• calendar year during which the education expenses were paid,

• name and address of the school,

• name and address of the parent or guardian who paid,

• name and Social Security number (SSN) of the student,

• grade level of the student,

• total* amount of education expenses paid to the school for each qualifying student's tuition, book fees, and lab fees during the calendar year.

*The person who paid the education expenses will use the total of the expenses minus $250 to calculate the allowable credit.

Note: All information on the receipt is confidential information for use only as supporting documentation of the education expense credit claimed and shall not be used for any other purpose.

PUB-112 (R-02/15)

Sample Written Receipt for Schools Education Expense Credit _ i General Rules and Requirements for Sc~

<{) Illinois Department of Revenue

Receipt for Qualified K-12 Education Expenses To be completed by school personnel and distributed to parents or guardians ----

Calendar year

Read this information first Parents or Guardians: Attach this receipt to your Form IL-1040, Individual Income Tax Return, if you figure an Ill inois Income Tax credit for education expenses.

I Note !To figure the amount of your credit, you must complete Schedule ICR, Illinois Credits.

Step 1: School Information:

Name of school

Address of school

City, State, ZIP of school

Step 2: Parent or Guardian Information:

Name of parent or guardian

Address of parent or guardian

City, State, ZIP of parent or guardian

Step 3: Student Information:

1 Complete the following information for each qualifying student from the family listed above. Please list each student on a separate line.

Column A Column B Column C Column D Student's name Social Security number Grade Total tuition,

(K-12 only) book/lab fees

a --- --- - ---- --b --- --- ----- --

C --- --- ----- --d --- --- . ---- --

e --- - -- ----- --f --- --- . ---- --g --- . -- . ---- --2 Add the amounts in Column D for Lines 1 a through 1 g. This is the total amount of

qualified education expenses paid to this school for the calendar year. 2

IL-1040-Rcpt (R-02/15)

PUB-112 (R-02/15) Page 3 of 4

I Office locations I

200 South Wyman Street

Maine North Regional Building

9511 Harrison Street FA 203 Des Plaines, Illinois 60016-1563 84 7 294-4200

Rockford, Illinois 61101-12371---......:.,. __ _

815 987-5210

Education Expense Credit General Rules and Requirements for Schools

James R. Thompson Center

--'111--t Concourse Level 100 West Randolph Street Chicago, Illinois 60601-3274 800 732-8866 217 782-3336

_________ ..,_.,.Willard Ice Building

15 Executive Drive

Business Center One, Suite 2

Fairview Heights, Illinois 62208-1331 618 624-6773

2309W. Main

Suite 114 Marion, Illinois 62959-1196 618 993-7650

For information Visit our website at tax.illinois.gov.

or forms Call us at 1 800 732-8866 or 217 782-3336.

Call our TDD (telecommunications device for the deaf) at 1 800 544-5304.

101 West Jefferson

Springfield, Illinois 62702 800 732-8866 217 782-3336

Write us at Illinois Department of Revenue, P.O. Box 19044, Springfield, IL 62794-9044.

Page 4 of 4 PUB-112 (R-02/15)

{J Illinois Department of Revenue

Receipt for Qualified Education Expenses To be completed by school personnel and distributed to parents or guardians

Calendar year

Recipients: Attach this receipt to your Form IL-1040, Individual Income Tax Return, if you figure an Illinois Income Tax credit for education expenses. You may have more than one receipt if you have more than 5 students attending the same school or if your children attend different schools.

=Note 4. You must complete the ED Worksheet in the Form IL-1040 Instructions to figure the amount of your credit.

Received From:

(This required information may be provided by the recipient.)

Name of parent or guardian

Address of parent or guardian

City, State, ZIP of parent or guardian

Social Security number of parent or guardian

Name of Student

1 _________ _

2 _________ _

3 _________ _

4 _________ _

5 _________ _

Social Security Number (This required information may be provided by the recipient)

Grade (K-12only)

Paid to:

Tuition

6 Add the amounts in the "Total" column. This is the amount of your education expenses. Write this amount on Line 1 of the ED Worksheet found in the Form IL-1040 Instructions. The ED Worksheet allows you to figure your education expense credit.

IL-1040-Rcpt (R-1/04)

Name of school

Address of school

City, State, ZIP of school

Telephone number of school

Book Fees Lab Fees

Total

Total