Tuition Waiver Application Form - Kentucky Department Of Veterans Affairs (Page 2 of 2) in pdf

Applicant

I hereby certify, under penalty of law, that the information given in this application is correct and complete to the best

of my knowledge. I am aware that, should investigation at any time show falsification, I will not be considered for

tuition waiver or, if already receiving tuition waiver, I will be disqualified from future eligibility. I hereby authorize the

Kentucky Department of Veterans Affairs and agencies to which my name is certified/ referred to make all necessary

investigations concerning me, my status, eligibility, or my action in any transaction. I authorize the Kentucky

Department of Veterans Affairs to receive and make available to state institutions of higher education my records

attached in support of this application, and further authorize and request each institution, agency or organization to

provide all information that may be sought in connection with my application. I understand and agree that I will be

required to ratify the information contained in this application by signature below as a condition of eligibility. I

understand that this application is to determine eligibility for tuition waiver provided by the Commonwealth of

Kentucky under Kentucky Revised Statutes. I understand that certification of eligibility is made only by the Kentucky

Department of Veterans Affairs.

Signature of Applicant ________________________________________ Date Signed _______________________

Please send completed application and documentation to:

Kentucky Department of Veterans Affairs, Attn: Tuition Waiver Coordinator, 321 West Main Street,

Suite 390, Louisville, KY 40202 or FAX to (502) 595-3369

***

***ALL REQUIRED DOCUMENTATION/INFORMATION MUST ACCOMPANY APPLICATION

***********FOR KDVA USE ONLY***********

KRS 164.505: Veteran died on active duty __________ and joined the military from Kentucky __________, and

applicant has proven relationship to veteran __________, and applicant is either a child of any age or an unremarried

spouse __________.

KRS 164.505: Veteran was honorably discharged __________ and veteran died as a result of service-connected

disabilities __________, and joined the military from Kentucky __________, and applicant has proven relationship to

veteran __________, and applicant is either a child of any age or an unremarried spouse __________.

KRS 164.507: Veteran was honorably discharged __________ and veteran died as a result of service-connected

disabilities __________, or veteran is a wartime veteran __________ and veteran was a Kentucky resident at the

time of death __________, or veteran was married to a Kentucky resident at the time of death __________, and

applicant has proven relationship to veteran __________, and applicant is either a child under the age of 26 or an

unremarried spouse of the veteran__________.

KRS 164.515: Veteran was discharged under honorable conditions __________, and veteran is a Kentucky resident

__________, and applicant has proven relationship to veteran __________, and applicant is either a child under the

age of 26 or a spouse of any age __________, and veteran is Missing in Action __________, or veteran is 100%

service connected disabled __________, or veteran is totally disabled by the Department of Veterans Affairs (

receives Pension) __________ and veteran is a wartime veteran __________, or veteran is totally disabled

__________ and was a Prisoner of War __________.

Approved/Disapproved: _______________________ Date: ________________ Effective Date: ______________

Chapter: ___________________________________ Certificate Number: ________________________________

Application 2012-13 - TW

Tuition Waiver Application Form - Kentucky Department Of Veterans Affairs Page 2