Missouri State Funded Tuition Assistance Application Page 2

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MISSOURI STATE FUNDED TUITION ASSISTANCE APPLICATION

This form must be completed digitally (except for signatures), hand written applications will not be accepted

Air:

Army:

Applicant’s Name :

(Last, First, Middle Initial)

Rank :

Social Security Number:

Unit of Assignment:

Select Rank

Last 4 Only

Current Mailing Address:

Phone Number:

Email Address:

(This email address will be used for correspondance

pertaining to the status of your TA applicaion!)

___________________________________________________________________________________________________

Date of Enlistment/Appointment:

ETS Date:

(Must be after last day of class(es).

YYYYMMDD

If the start date of your class(es) is more than 1 year from the date you graduated AIT/BOLC you must use all

(

AIT/BOLC Graduation date:

available Federal TA before being approved for State TA)

YYYYMMDD

)

Are you a first time college freshman? Yes:

No :

(If you answered no, you must submit your most recent transcript with this application

If yes, when?

Have you previously received MO state funded education assistance? Yes:

No:

Year, Semester

College/University Name:

Select College / University

(If your school is not on this dropdown it is not on the approved State TA list)

Credit Hours:

Which semester are you applying?

Select Semester

Start date of classe s:

YYYYMMDD

The following documents are being submitted with this application:

-Statement of Understanding

-Course Schedule (Must have School and applicant's name on the document)

-Itemized Bill (Must have School and applicant's name on the document)

-Transcript (Not applicable if you are first time college freshman)

If the completed application with the documents above are not submitted by the start date of class(es) my application will be denied.

Are you using Ch 1606 or 1607 GI Bill?

Yes

I certify all of the above information on this form is true and complete to the best of my knowledge. Complete applications are due by

the start date of class. I understand that late submisssion will result in my application being denied.

Applicant’s Signature:

Date:

YYYYMMDD

COMMANDER’S CERTIFICATION

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

Name:

Date:

(Last, First, Middle Initial

After Commander signs email complete application to ng.mo.moarng.mbx.per-inc-stateta@mail.mil for Army or ng.mo.moang.mbx.ang-ta-mail@mail.mil for Air.

DO NOT WRITE BELOW THIS LINE. STATE TA OFFICE USE ONLY.

_____________________________________________________________________________________________________________________________________

Fed paid for _____hrs at $250/ch, leaving State responsible to pay for the difference

AIT completed more than 1 year ago? ______

of the actual ch cost of ____ - $250= $______ x ____ch's=

$_______________

CHs applied for this semester: _______

PLUS

Fed TA expended this FY: _______

State pays for the remaining _____hrs at $______=

$_______________

Fed hours paid towards this semester: _______