Exhibit D
Internal Revenue Bulletin 2003-16 · 2026-10-03 edition · updated 2026-10-04 · United States
.33"
Form 1098-T Cat. No. 25087J Department of the Treasury - Internal Revenue Service
Do Not Cut or Separate Forms on This Page - Do Not Cut or Separate Forms on This Page
Tuition Statement
Copy A
For Internal Revenue
Service Center File with Form 1096.
For Privacy Act
and Paperwork
Reduction Act Notice, see the
2003 General Instructions for Forms 1099, 1098,
5498, and W-2G.
| FILER’S name, street address, city, state, ZIP code, and telephone number | 1 Payments received for qualified tuition and related expenses $ |
OMB No. 1545-1574 2003 Form 1098-T |
||
|---|---|---|---|---|
| FILER’S name, street address, city, state, ZIP code, and telephone number | FILER’S name, street address, city, state, ZIP code, and telephone number | 2 Amounts billed for qualified tuition and related expenses $ |
2 Amounts billed for qualified tuition and related expenses $ |
2 Amounts billed for qualified tuition and related expenses $ |
| FILER’S Federal identification no. | STUDENT’S social security number | 3 Adjustments made for a prior year $ |
4 Scholarships or grants $ |
4 Scholarships or grants $ |
| STUDENT’S name | STUDENT’S name | 5 Adjustments to scholarships or grants for a prior year $ |
||
| Street address (including apt. no.) | Street address (including apt. no.) | 6 Check this box if the amount in box 1 or 2 includes amounts for an academic period beginning January- March 2004 |
7 Reimbursements or refunds of qualified tuition and related expenses from an insurance contract $ |
7 Reimbursements or refunds of qualified tuition and related expenses from an insurance contract $ |
| City, state, and ZIP code | City, state, and ZIP code | City, state, and ZIP code | City, state, and ZIP code | City, state, and ZIP code |
| Service Provider/ |
Service Provider/ |
8 Check if at least half-time student |
9 Check if a graduate student |
9 Check if a graduate student |
| Service Provider/ |
Service Provider/ |
8 Check if at least half-time student |
9 Check if a graduate student |
Form 1098-T Cat. No. 25087J Department of the Treasury - Internal Revenue Service
Do Not Cut or Separate Forms on This Page - Do Not Cut or Separate Forms on This Page
Tuition Statement
Copy A
For Internal Revenue
Service Center File with Form 1096.
For Privacy Act
and Paperwork
Reduction Act Notice, see the
2003 General Instructions for Forms 1099, 1098,
5498, and W-2G.
| FILER’S name, street address, city, state, ZIP code, and telephone number | 1 Payments received for qualified tuition and related expenses $ |
OMB No. 1545-1574 2003 Form 1098-T |
||
|---|---|---|---|---|
| FILER’S name, street address, city, state, ZIP code, and telephone number | FILER’S name, street address, city, state, ZIP code, and telephone number | 2 Amounts billed for qualified tuition and related expenses $ |
2 Amounts billed for qualified tuition and related expenses $ |
2 Amounts billed for qualified tuition and related expenses $ |
| FILER’S Federal identification no. | STUDENT’S social security number | 3 Adjustments made for a prior year $ |
4 Scholarships or grants $ |
4 Scholarships or grants $ |
| STUDENT’S name | STUDENT’S name | 5 Adjustments to scholarships or grants for a prior year $ |
||
| Street address (including apt. no.) | Street address (including apt. no.) | 6 Check this box if the amount in box 1 or 2 includes amounts for an academic period beginning January- March 2004 |
7 Reimbursements or refunds of qualified tuition and related expenses from an insurance contract $ |
7 Reimbursements or refunds of qualified tuition and related expenses from an insurance contract $ |
| City, state, and ZIP code | City, state, and ZIP code | City, state, and ZIP code | City, state, and ZIP code | City, state, and ZIP code |
| Service Provider/ |
Service Provider/ |
8 Check if at least half-time student |
9 Check if a graduate student |
9 Check if a graduate student |
| Service Provider/ |
Service Provider/ |
8 Check if at least half-time student |
9 Check if a graduate student |
Form 1098-T Cat. No. 25087J Department of the Treasury - Internal Revenue Service
April 21, 2003 781 2003–16 I.R.B.
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