Tuition Waiver Application Form - Kentucky Department Of Veterans Affairs printable pdf download

KENTUCKY DEPARTMENT OF VETERANS AFFAIRS

TUITION WAIVER APPLICATION

please print clearly.

Applicant Data

1. First Name ______________________ Middle _________________ Last Name ________________________

2. Address __________________________ City ____________________ State/Zip Code ___________________

3. Date of Birth __________________ Soc Sec # ____________________ Telephone _____________________

4. What is your relationship to the veteran? (Specify biological child, adopted child, **stepchild, spouse, widow, or

widower.)

__________________Attach appropriate documentation birth certificate, marriage certificate,

adoption paperwork, **step child affidavit * required*

5. Are you a Kentucky resident? _________ did/do you reside in the veteran’s household? _________________

6. Full Name of school you are enrolled in? _______________________ Campus Location_________________

7. Anticipated enrollment date (or original date of enrollment if already enrolled) ___________________________

8. Have you or any member of the veteran’s family previously been issued a Tuition Waiver Certificate?

__ Yes___ No

If yes, Certificate Number __________ Name of person_______________________________

9. If spouse of deceased veteran, are you remarried? _______ Yes

_______ No

10: E-MAIL ADDRESS?________________________@______________________

*REQUIRED*

Living Veteran

1. First Name ______________________ Middle _________________ Last Name ________________________

2. Address ____________________________ City ____________________ State/Zip Code _________________

3. Telephone ______________________ Date of Birth _____________ KY Resident? ______________________

4. Soc Sec # _______________________ VA File # __________________

5. Home of Record at time of entry into service ______________________________

(Attach DD214.) * required*

6. Dates of Service ____________________________ Character of Service: _____________________________

** You MUST attach a copy of Disability award letter from the Department of Veterans Affairs**

7. Is the veteran 100% disabled? _________

8. Does the veteran receive compensation from the Department of Veterans Affairs?_____________

Deceased Veteran

1. First Name ______________________ Middle _________________ Last Name ________________________

2. Last Known Address: City _______________________________ State/Zip Code _______________________

3. Date of Birth _____________________ Date of Death _______________________

(Attach death

certificate.)

4. Residence at time of death _____________________ Cause of Death ____________________________

5. Soc Sec # _______________________ VA File # __________________ Service # ______________________

6. Home of Record at time of entry into service __________________________

(Attach DD214 if

applicable.)

7. Dates of Service ______________________________ Character of Service: ___________________________

8. Died on Active Duty? _______ Yes

_______ No (If yes, attach casualty report.)

9. Was the veteran totally disabled at time of death? ___________

10. Was the veteran receiving VA disability at time of death? ___________________

(Attach VA Rating Decision.)

Application 2012-13 - TW

Tuition Waiver Application Form - Kentucky Department Of Veterans Affairs

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