NEVADA NATIONAL GUARD STATE EDUCATION TUITION FEE WAIVER (SEE ...

NEVADA NATIONAL GUARD STATE EDUCATION TUITION FEE WAIVER (SEE PAGE 2 FOR INSTRUCTIONS)

1. The Adjutant General may authorize the payment of not more than 100 percent of the consolidated fee each semester for each member of the active Nevada National Guard who attends one of the universities or state colleges within the Nevada System of Higher Education as a full-time or part-time student from money appropriated for this purpose. 2. The Adjutant General may authorize the payment of not more than 100 percent of the credit-hour cost each semester for each member of the active Nevada National Guard who attends one of the community colleges within the Nevada System of Higher Education as a full-time or parttime student from money appropriated for this purpose. 3. To be eligible to receive benefits, a person must be a member in good standing of the active Nevada National Guard at the beginning of and throughout the entire semester for which benefits are received. (Added to NRS by 1973, 687; A 1977, 3; 1983, 537; 1993, 401; 1999, 1978; 2005, 366)

1) Print Name (Last, First, MI):

PART A - PERSONAL INFORMATION 2) Rank:

3) Last 4 of SSN:

4) Affiliation: 7) Mailing Address:

5) Unit: 8) Home Phone:

6) ETS

9) City, State, Zip

10) Work Phone:

11) Email:

12) Cell Phone:

13) Major:

14) Degrees Held:

15) Graduation Date:

16) Degree Sought:

17) Projected Grad Date:

18) College/University attended:

19) Total Credit Hours Enrolled:

20) Term:

21)Year:

PART B - STATEMENT OF UNDERSTANDING

I have been counseled by my unit commander in regards to the eligibility requirements as stateed in the Nevada Revised Statute 412.1435

and the Nevada National Guard education eligibility and requirement policy. I also understand that I must achieve a minimum of a 2.0

grade point average for the semester or I will be held liable to the Board of Regents for all fees waived by the university or college. If I am a

recruit who fails to enter full-time National Guard duty within one year of enlisting, I will be liable to the Board of Regents for all fees waived

by the university or college. I understand that I must immediately repay any and all fees or debts to which I have incurred from the time I

become ineligible for the program. Failure to repay this debt shall result in the with holding of my transcript record and denial of registration

until such time as the debt is paid in full. I further certify that I am not flagged for any reason and am currently in good standing with my

unit and the Nevada National Guard.

Member's Signature

Date of Signature

PART C - UNIT CERTIFICATION I hereby certify that this individual is currently a member in good standing, IAW AR 600-200 or ANGI 36-2001, and I will notify the Nevada

National Guard Education Office of any changes in this individual's status. Battalion/Squadron Career Counselor Printed Name:

Battalion/Squadron Career Counselor Signature & Date:

PART D - EDUCATION OFFICE CERTIFICATION I hereby certify that this individual is currently a member in good standing, IAW AR 600-200 or ANGI 36-2001. Tuition Waiver Control Number: Education Representative Name:

Education Representative Signature & Date:

PART E - CASHIER'S USE ONLY

Cashier's Printed Name:

Cashier's Signature and Date:

ALipstpeldication Instructions below are

Part A

Block 1: LAST NAME, FIRST NAME MI

Block 2: RANK/ GRADE

Block 3: APPLICANT'S LAST FOUR DIGITS OF THEIR SOCIAL SECURITY NUMBER

Block 4: AFFILIATION- Select "ARMY" if you are ARNG or "Air" if you are ANG

Block 5: UNIT: List your current unit of assignment by name and include UIC

Block 6:

Applicant's current ETS. ETS must extend throught the entire semmester that the Soldier/Airman is attending school.

Blocks 7-12: Fill in basic information to include address, work phone number, cell phone number and email address

Block 13: Current Major the Soldier/Airman is attempting to complete

Block 14: Block 15: Block 16: Block 17: Block 18: Block 19: Block 20: Block 21:

Part B

Part B:

Degree held by the Soldier/Airman. If multiple degrees are held, list the most recent degree. If Soldier/Airman holds a degree as annotated in block 13, please list the graduation date of the most recent Degree the Soldier/Airman is currently seeking Soldier's projected graduation date for the current degree being sought Please select the College or University that you are attending from the given drop down options. Total credit hours enrolled (how many credits are you taking this term). i.e. 3,6,9 etc Term that the Soldier/Airman is attending (i.e. Summer, Fall, or Spring) The year the Soldier/Airman is attending school

In this area, the Soldier/Airman will certify that he or she understands the requirements to be met by participating in the State Education Tuition Waiver Program.

Part C

Part C is reserved for the certification and signature of the Soldier's/Airman's Battalion Career Counselor.

Part D Part E

Part D is reserved for the certification and signature of the State Education/ Incentives Manager. Part E is reserved for the use of the College/ University's Cashier's office.

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