Form Annex E-1 - Obligation Request Form - 2015-2016

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MN National Guard Circular 621-5-1
Annex E-1
1 July 2015
ANNUAL OBLIGATION FORM
EXTENDED STATE TUITION REIMBURSEMENT
MINNESOTA NATIONAL GUARD
2015-2016
-----DATA REQUIRED BY THE PRIVACY ACT OF 1974-----
AUTHORITY: Minnesota Statute 192.501 Financial Incentives for National Guard Members
PRINCIPAL PURPOSE: To explain participation requirements for extended state tuition reimbursement (E-STR) program,
to ensure that your agreement to these conditions is a matter of record, and to obligate funds for the current FY.
ROUTINE USES: To confirm requirements of obligation and participation for the E-STR program as a basis for suspension,
termination and recoupment if requirements are not met. Due no later than 45 days after the course/term start date.
DISCLOSURE: Disclosure of your SSN is voluntary; however, if not provided, you will not be eligible for the E-STR
program.
DISCLAIMER: The funding available for the E-STR program is limited by an appropriation set by the state legislature. This
contract is valid for payment provided funds are available in each fiscal year of eligibility.
E-1. ACKNOWLEDGEMENT STATEMENT.
I, ____________________(full name), certify I have read this memorandum prior to signing and fully understand
the policies and procedures of the Minnesota extended state tuition reimbursement (E-STR) program as
described in Minnesota National Guard Circular 621-5-1 and this annual obligation form.
E-2. INTRODUCTION.
a.
(initial) The State of Minnesota sponsors the E-STR program. The state legislature appropriates
funds for this program biennially. If in the future the state does not fund the E-STR program, or if funds are
depleted, neither the State of Minnesota nor the Minnesota National Guard is obligated to continue such a
program or pay out existing obligations.
b.
(initial) I understand the E-STR program will reimburse me up to 100 percent of the semester-
hour tuition charged, not to exceed a maximum of $17,000 per state fiscal year for undergraduate coursework
and $36,000 for graduate coursework. I understand my reimbursement will not exceed 100 percent of the
University of Minnesota (U of M) Twin Cities undergraduate campus resident semester-hour rate for
undergraduate coursework or the resident general tuition rate at the U of M Twin Cities graduate school for
graduate coursework. The maximum reimbursement for quarter hours is two-thirds (66.6 percent) of the
semester-hour rate at the U of M.
c.
(initial) I understand the U of M tuition rates for the current academic year can be found at
d.
(initial) I understand that if I receive Chapter 33 Post 9/11 GI Bill (or any other federal GI Bill
chapter which pays directly to the institution) and/or an ROTC tuition scholarship, the combination of those
benefits and E-STR cannot exceed 100 percent of my tuition cost.
e.
(initial) I understand reimbursement is not authorized for activity fees, computer user fees,
registration fees, books, room and board expenses and other school-related fees.
E-3. CRITERIA FOR PARTICIPATION.
a. I understand the following requirements for participation:
(1)
(initial) I have satisfactorily completed my service contract with the MNNG per paragraph 2-2
of the MN State Circular 621-5-1 and I am not currently serving in any branch of the U.S. Armed Forces under
an active service contract.
(2)
(initial) I must attend course(s) taken at an accredited post-secondary educational institution
and course(s) must be eligible for placement on a transcript.
ANNEX E-1 EXTENDED STR ANNUAL OBLIGATION FORM

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