Form RPD-41279 Job Mentorship Tax Credit Certificate Request Form

The number of certificates requested in a school year by a qualifying school cannot exceed the number of qualified students participating in the school sanctioned career preparation education program on October 15 of the applicable school year 1 Enter the beginning and ending dates of the school year for which Job Mentorship Tax Credit certificates are requested A separate request form must be submitted for each school year 2 Enter the number of certificates requested Career Preparation Education Program means a work based learning or school to career program designed for second ary school students to create academic and career goals and objectives and find employment in a job meeting those goals and objectives Certifications (You must check the applicable boxes) City state and ZIP code Contact name Definitions E mail address From through I certify that the school named above: is an accredited New Mexico secondary school Job Mentorship Tax Credit Certificate Request Form Mailing address Name of New Mexico accredited secondary school participates in a school sanctioned career preparation education program and Purpose of this form An accredited New Mexico secondary school sponsoring a school sanctioned career preparation education program may use this form to request Job Mentorship Tax Credit Certificates (Form RPD 41281) from the Depart ment The principal of an eligible school must submit a completed Form RPD 41279 to a local district tax office to obtain the certificates The Department may issue a maximum number of certificates equal to the number of qualified students in the school sanctioned career preparation education program on October 15 of that school year as certified by the school principal See the definitions below For assistance call (505) 476 3683 Qualified Student means an individual who is at least 14 years old but not more than 21 years old who is attending an accredited New Mexico secondary school full time and who is a participant in a career preparation education program sanc tioned by the secondary school Rev 07/2010 RPD 41279 Signature of the school principal Date STATE OF NEW MEXICO TAXATION AND REVENUE DEPARTMENT Telephone number that the number of certificates requested does not exceed the number of qualified students participating in the career preparation education program sanctioned by this school on October 15th of the school year indicated above The principal of the New Mexico accredited school must complete this form