State Funded Tuition Assistance Application printable pdf download

STATE FUNDED TUITION ASSISTANCE APPLICATION

Applicant’s Name :________________________________________________________

(Last, First, Middle Initial)

Rank: ________ Social Security Number: ________________ Unit of Assignment: _________________________________

Current Mailing Address: ____________________________________________________________

(Street Address to include Apartment #, if applicable)

____________________________________________________________

(City, State, and Zip Code)

Applicant’s Telephone Number: (

) _______ -___________

Pay Entry Basic Date (Army): ____/ ____/ ______

Pay Date (Air) (Start Date):____/ ____/______

DD MM YYYY

ETS Date: ______________________

Are you a first time college freshman? (Check One)

Yes _______

No _______

Do you have prior Missouri National Guard Service? (Check One) Yes ______ No ______

Have you previously received MO state funded education assistance?: Yes ______ No __ ____

If you answered Yes – Dates last used: From _____________________ To _____________________

For which semester are you applying? (Check One) Fall ______ Spring ______ Summer ______

College/University Name: __________________________________ ______ Start date of classes: _____________________

How many credit hours are you enrolled in: ______________________ Cost of tuition only per hour: _________________

ARNG applicants: Have you requested Federal Tuition Assistance? Yes ______ No ______

I certify all of the above information on this form is true and complete to the best of my knowledge.

I also certify that I have read the Statement of Understanding and understand that I must remain in an

“active” military status while enrolled in a se mester or session for which I am receiving education assistance,

except for death, disability, or medical disqualification. Failure to remain in an “active” status will result in

the recoupment of all monies awarded for that semester/session.

APPLICATIONS ARE DUE NO LATER THAN 30 DAYS AFTER THE START DATE

OF CLASS. Late submission may result in a denial of tuition assistance and will be required to go

before the Education Board for Approval.

Applicant’s Signature: ___________________________________ ______________

Date: _________________________

COMMANDER’S CERTIFICATION

I certify that the above applicant is a satisfactory participant and a member in good standing in the Missouri National

Guard.

Printed Name and Grade _

____________________________________

Commander’s Signature: _________________________________________________ Date: _______________________

State Funded Tuition Assistance Application