Form Tvc-Ed-1a Texas Hazlewood Act Exemption Application Page 2
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1
2
3Texas Hazlewood Act Exemption
TVC‐ED‐1
Eff. June 2014
Application
Page 1 of 2
For (Term) (Year)
SUBMIT THIS APPLICATION TO YOUR COLLEGE OR UNIVERSITY
Each Veteran, child, or spouse applying to receive an exemption through the Hazlewood Act, (Texas Education
Code §54.341) must complete and sign this application and provide the institution with the documentation
required to verify eligibility as indicated in this packet. Submit this application and all supporting
documentation to your institution’s Hazlewood Exemption administrator.
I am applying as:
[
] a Veteran intending to use the Hazlewood Exemption
[
] a child intending to receive a Legacy transfer of benefits
[
] a child of a totally disabled, service‐related deceased, KIA, or MIA Veteran
[
] a spouse of a totally disabled, service‐related deceased, KIA, or MIA Veteran
I am:
[
] an applicant applying for the first time; or
[
] a previous Hazlewood recipient who has used hours at institution(s).
Total prior hours used: Veteran , Legacy
, Spouse , Child
(transferred hrs.)
(w/own hrs.)
Part A – Veteran’s Information
Veteran’s Name:
Last Name
First Name
MI
Veteran’s SSN:
Date of Birth: / /
(MM/DD/YYYY)
Veteran’s Student ID#:
Address:
Street
City
State
Zip Code
Phone Number:
Email address:
Part B – Other User Information
Relationship to Veteran:
[
] Biological Child [
] Step‐child [
] Adopted Child [
] IRS Dependent [
] Spouse
Child’s/Spouse’s Name:
Last Name
First Name
MI
Child’s/Spouse’s SSN:
Date of Birth: / /
(MM/DD/YYYY)
Child’s/Spouse’s ID#:
Address:
Street
City
State
Zip Code
Phone Number:
Email address:
Part C – Loan Verification
To qualify for the Hazlewood Exemption, the Veteran, child or spouse cannot be in default on a loan that is
made or guaranteed by the state of Texas. State loans can be viewed at
Does the Veteran, child or spouse have a loan through the Texas Higher Education Coordinating Board?
[
] Yes
[
] No
If yes, is the loan in default status?
[
] Yes
[
] No
TEXAS VETERANS COMMISSION
Phone: 1‐877‐898‐3833 or 512/463‐3168 | TTY/TDD: Dial 711 | Fax: 512/463‐3932 | E‐Mail: Education@tvc.texas.gov | Web:
An Equal Opportunity Employer
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