Police Officers & Firefighters Memorial Tuition Waiver Form printable pdf download

Police Officers and Firefighters Memorial Tuition Waiver

KRS 164.2841

Must be the child or nonremarried spouse of a person who was a Kentucky resident on becoming a law

enforcement officer, firefighter or volunteer firefighter and who was killed in the line of duty or died from a service

connected disability after June 30, 1989. Proof of relationship to the deceased and the circumstances of the death must be

provided in writing by official documentation in order to process this waiver. Full tuition.

KRS 164.2842

Must be the child (over age 17 and under age 23) or nonremarried spouse of a person who was a

Kentucky resident on becoming a law enforcement officer, firefighter or volunteer firefighter and who was permanently

and totally disabled in the line of duty. Must provide official proof of relationship and official documentation of the

qualifying disability in order for this waiver to be processed. Full tuition for up to 36 months.

Name: ______________________________________________ ID #: _____________________________

Address: _______________________________________________________________________________

City: ________________________________________ State: __________ Zip: ____________________

Date of Birth: ______________________ Semester plan to enroll at EKU: _________________________

Applicant’s relationship to the deceased / disabled: ____________________________________________

Name and address of employer of deceased / disabled at time of death / disability:

__________________________________________________________

Phone number of employer: ___________________________________

I authorize the Scholarship Office to verify the above information in order to process this waiver. This waiver cannot be

used concurrently with any other tuition waivers, which includes but not limited to institutional awards, scholarships and

other state mandated, University funded waivers. I hereby state that all information provided is accurate and understand

the knowingly providing incorrect information will void this waiver and all future use of the waiver at Eastern Kentucky

University.

_____________________________________________________

________________________________

Signature of applicant

Date

OFFICE USE ONLY:

Verified By: ___________________________________________ Date: ______________________________

_________ Birth Certificate _______ Social Security Card ________ Documentation of duty related

death/disability

_________ Eligible

_________ Ineligible

Created on 5/24/05

Police Officers & Firefighters Memorial Tuition Waiver Form