Military Verification Form
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The Texas Education Code Chapter 54.058 (b) provides that military personnel assigned to duty within the State of Texas,
their spouse, and their dependent children shall be entitled to pay the same tuition as a resident of Texas. This same
provision also applies to commissioned Public Health Officers, their spouses, and their dependents. To be entitled to pay
the resident tuition, this Military Duty Statement must be submitted to the Residency Department at least once per 12-
month academic year. An appropriately authorized officer in the service must certify that the individual is assigned to
duty in Texas and that such assigned duty is in effect at the time of enrollment in this public institution of higher
education.
This form must be completed prior to the beginning of the semester of enrollment and IS REQUIRED EACH YEAR.
SECTION I:
SPONSOR INFORMATION. This section must be completed.
____________________________________
SSN: _____________________
Sponsor:
(Name of Military Personnel)
Status:
Active: __________
Reserve: __________
:
__________________________________________________________________________
Duty Station
(Military Installation)
Home of Record:
__________________________________________________________________________
Military I.D. Card No: ____________________________
Expiration Date: _____________________
Semester of Enrollment (Circle):
Fall
Spring
Summer
Year: _________________
SECTION II: DEPENDENT INFORMATION.
*This section must be completed only if the military dependent is the student.
According to military records, the following individual is the dependent of the above-named military member.
_________________________________________
___________________________
(Name of Dependent)
(Social Security Number of Dependent)
Military I.D. Card No: ______________________
Expiration Date: ______________
.
SECTION III: SIGNATURE OF AUTHORIZED PERSONNEL
* This form is not valid without the signature below.
(SIGNATURE OF MILITARY PERSONNEL OFFICER, UNIT COMMANDER, EDUCATION OFFICER OR DESIGNATED
REPRESENTATIVE.)
________________________________________________
_________________________________
Signature of Authorized Officer
Telephone Number
____________________________________________________________
__________________________________________
Military Title
Grade
FOR ADMISSIONS AND RECORDS ONLY
Residency Code: __________
Verification: __________
Term: ___________
State: __________
Verified by: ___________
Date: ____________
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