Form Rpd-41279 - Job Mentorship Tax Credit Certificate Request Form - State Of New Mexico Taxation And Revenue Department

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RPD-41279
STATE OF NEW MEXICO - TAXATION AND REVENUE DEPARTMENT
Rev. 07/2010
Job Mentorship Tax Credit Certificate Request Form
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.
Name of New Mexico accredited secondary school
Mailing address
City, state and ZIP code
Contact name
Telephone number
E-mail address
Definitions
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.
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.
The principal of the New Mexico accredited school must complete this form.
1. Enter the beginning and ending dates of the school year for which Job
From
through
Mentorship Tax Credit certificates are requested. A separate request
form must be submitted for each school year.
2. Enter the number of certificates requested.
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.
Certifications. (You must check the applicable boxes)
3.
I certify that the school named above:
is an accredited New Mexico secondary school,
participates in a school-sanctioned career preparation education program, and
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.
Signature of the school principal
Date

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