Nvmd Form 37w - State Educational Encouragement Fund Request For Fee Waiver
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3Nevada National Guard
NEVADA NATIONAL GUARD
Education Officer
STATE EDUCATIONAL ENCOURAGEMENT FUND
2460 Fairview Drive
REQUEST FOR FEE WAIVER
Carson City, NV 89701-6807
(See Reverse for Instructions)
(775) 887-7258/7279
FAX: (775) 887-7279
PART A -- PERSONAL INFORMATION
1a. Name (Last, First, MI)
1b. Rank 1c. SSN
1d. Unit
1e. ETS Date:
1f. Affiliation (circle one) :
Army
Air
1g. Status (circle one ):
Technician
AGR
Traditional
2a. Mailing Address
2b. Home Phone:
Street or Box
2c. Work Phone:
City, State, Zip
2d. Cell Phone:
PART B -- EDUCATION INFORMATION
3. Degrees Held
4. Degree Sought
5.
UCCSN Institution (circle one ):
NONE
NONE
AA
AA
UNR
UNLV
NSC
TMCC
WNCC
CCSN
GBC
AS
AS
6.
Total Credit Hours Enrolled ___________________________
BA
BA
Term (circle one) :
Fall
Spring
BS
BS
Year ____________
MA
MA
7.
I have been counseled by my unit commander relative to the reasons for termination of my
MS
MS
eligibility under the Nevada National Guard Education Program and understand that I must
remain a member of the Nevada National Guard in good standing throughout the semester
MBA
MBA
attending and achieve at least a 2.0 GPA for the semester or I will be held liable to the Board of
Regents for all fees waived by the university or college. If I am a recruit who fails to enter full-time
MPA
MPA
National Guard duty within 1 year of enlisting, I will be liable to the Board of Regents for all fees
Doctorate
Doctorate
waived by the university or college. I understand I must repay immediately any fees to which I am
liable at the time I become ineligible for the program. Failure to repay this debt shall result in the
Professional
Professional
withholding of my transcript record and denial of registration until such time as this debt is paid in
full.
Certification
Certification
Major:
Major:
Member's Signature
Date
CASHIER'S USE ONLY:
Grad Date:
Projected Grad Date:
Amount Waived $_____________
This semester?
PART C -- COMMANDER'S CERTIFICATION
8. I hereby certify that this individual is currently a member in good standing, IAW AR 600-200 or ANGI 36-2001, and I
will notify the Nevada National Guard Education Office of any changes in this individual's status.
PRINT: Cmdr/Designated Rep Name & Rank
Cmdr/Designated Rep Signature and Date
NEVADA NATIONAL GUARD EDUCATION OFFICER SECTION
CONTROL NUMBER: ____________________
Telephone Number: (775) 887-7326
Fax Number: (775) 887-7258/7279
Fax Number: (775)887-7279
Air Guard: (775) 788-4543
Air Fax: (775) 788-4542
NVMD Form 37W R4, July 2005
Previous Editions are obsolete
Privacy Act Statement on Reverse
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