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PALO ALTO COLLEGE VETERANS AFFAIRS (210) 486-3111 Cettification Checklist Chapter 33 Post 9/11 Concise Student Schedule Account Summary by Term Request for Certification (PAC Green Form) Contract for Tuition (Alamo Colleges Carbon Form) Chapter 30 Montgomery G.L. Bill r *Degree Plan Concise Student Schedule ‘Account Summary by Term Proof of Tuition Payment Request for Certification (PAC Green Form) Hazlewood “Degree Plan Hazlewood Application Packet (Blue Packet) Concise Student Schedule Account Summary by Term Request for Certification (PAC Green Form) Hazlewood Act Exemption (Gold page) Hazlewood Hours Used Verification Page * If veteran is 100% disabled, disability letter is needed earner “Degree Plan Concise Student Schedule Account Summary by Term Proof of Tuition Payment Request for Certification (Green Form) “Documents required during First certification only Chapter 31 Disabled Veterans Vocational Rehab *Degree Plan VA Form 28-1905 (Authorization) Coneise Student Schedule Account Summary by Term (Two Copies) Request for Certification (PAC Green Form) Vouchers may be picked up 1 week prior to the start of the semester (Books and Supplies) Chapter 35 Survivors & Dependents Education “Degree Plan Concise Student Schedule Account Summary by Term Proof of Tuition Payment Request for Certification (PAC Green Form) *100% Disability Letter if using with Hazlewood Hazlewood Legacy (Dependent) “Hazlewood Application Packet (Blue Packet) Concise Student Schedule Account Summary by Term Request for Certification (PAC Green Form) Hazlewood Act Exemption (Gold page) Hazlewood Hours Used Verification Page * If veteran is 100% disabled, disability letter is needed ATTENTION TRANSFER STUDE! We need transcripts from UNIVERSITIES PREVIOUSLY ATTENDED Print out Unofficial Transcripts from ACES Revised 1/6/2017 VA ENROLLMENT CERTIFICATION REQUEST ‘The proponent department isthe College Veterans Affairs Office ALAMO a a re ‘AUTHORITY: Pal Alto College Catalog TATBTALTO CBthaoe PRINCIPAL PURPOSE: Request by student to receive certification enrollment for veteran benefits ROUTINE USES: Used to evaluate and determine certification fr Federal and State veteran benefits. DISCLOSURE: Voluntary. Fallue to furnish information may resutin denial of certification. 1. STUDENT BANNER ID 2. HOME COLLEGE 3. DATE OF REQUEST nc ONve Grac Osc Osac ‘STUDENT NAME (LAST, FIRST, MI) 5. ACES EMAIL 6 DATE OF BIRTH @student.alamo.edu| 7. PRIMARY STREET ADDRESS 9. STATE TL. PRIMARY PHONE 112. EMERGENCY CONTACT PHONE 13. CHANGE OF ADDRESS? z Dyes ONO 14, SOCIAL SECURITY NUMBER 15. DEGREE 16. DEGREE/AREA OF STUDY CAA DIAS CAAS DAAT CICERTIFICATE ‘** IMPORTANT NOTE** INTERNET DEVELOPMENTAL CLASSES CANNOT BE CERTIFIED FOR VA BENEFITS. *VA WILL COVER THE COST OF TUITION, BUT NOT THE 3-PEAT FEE FOR ANY CLASSES. “ALL CHANGES IN ENROLLMENT (ADD/DROP/WITHDRAW) MUST BE REPORTED IIMMEDIATELY OR YOU MAY BE LIABLE FOR UNPAID CHARGES. 117. MILITARY STATUS (PLEASE SELECT ONE) COVETERAN C1 FAMILY MEMBER-SPOUSE _[] FAMILY MEMBER-CHILD. 118. REQUESTED BENEFIT(S) (PLEASE SELECT ALL THAT APPLY) COCHAPTER 30 MONTGOMERY GI BILL Ci CHAPTER 31 REHABILITATION COCHAPTER 33 POST 9/11 GI BILL CCHAPTER 35-DEPENDENT CLAIM # CICHAPTER 1606 RESERVE/NATIONAL GUARD CI CHAPTER 1607 REAP OHaztewooo CLHAZLEWOOD LEGACY VA FORM 1, DEC 2016 Page 1 of2 ume Cet Suse ices V0 Alamo Colleges ‘San Antonio College, St. Philip's College, Palo Alto College, Northwest Vista College, Northeast Lakeview College Contract for Tlton Payment Chapter 33 Veteran Students Only sare so Adress PALS aecount/Personal e-mail ey areas Telephone (comment 1 understand that vill pay my semester tution at 100%, (ramel ‘eollege) (semester) 1am notified by the College of any changes, Iwill eontact the Business Office as oan ae possible but o later than 30 days from the notification date for any amount due to the College and pay immediate, ‘renws: 1 Student enrois in one af the Alamo Colleges. 2 Student apples for the Certification of Elbit thew ether the College's Veteran afi Office or rect tothe US, Department of Veterans fais on VONAPP (ww GIL ov) 3a. Alamo Colleges is responsible to refund the U.S. Department of Veteran Affairs in the case where a student fis to attend ne class day. Ifthe student attends atleast one day of ass anda refund is processed iti the students responsiblity to refund the U.S, Department of Veteran Afi, CONDITIONS: 1 Inthe event thatthe student snot eligible forthe maximum eiblty, payment must be recelved by the College within 30 days as described in the terms above. tis the students responsibilty to make payment within the appropriste dates without regards for the Colleges billng procedures or posta delays 2 Hfenroliment is terminated for any reason, the unpaid balance of tution and fees fe due and payable immediately 3 The retun ofa nonsufcient fund check does not constitute a drop. ia check returned by the makers bank unpaid, the make is responsible for the unpaié balance, plus the return check charge, which i ue immediately, 4 ANY UNPAID BALANCE WILL BE TURNED QVER FOR COLLECTION TO A COLLECTION AGENCY. THE FEE CHARGED BY THE ‘COLLECTION AGENCY WILL BE ADDED TO THE STUDENT'S ACCOUNT. The College's failure to enforce all terms and conditions stated herein shall not constitute a waiver ofthe underlying obligations agreed toby the student. 5 ASTUDENT WHO FAIL TO MAKE FULL PAYMENT OF TUITION AND FEES, INCLUDING ANY INCIDENTAL FEES, BY THE DUE DATE MAY BE PROHIBITED FROM REGISTERING FOR CLASSES UNTIL FULL PAYMENT IS MADE. ITS HEREBY AGREED THAT: "acknowledge and accept responsibilty forall debts plus any collection fees owed t the Alamo Colleges under the terms and cantons stated herein, and agree that + Il notty Admissions and Records of any change in my maling address; + Ill not be alowed to register for any succeeding academic priag unless al debts to the Cllege have been paid and + Ill ot be allowed to receive an official ransrptof any work completed atthe Alamo Colleges unless all debts tothe College have been pai. RR apg Fromage ornare TaicaenoTe a ‘Alas 20 ath tut ethan ont At lst 8 month then 28 ahs? ‘less Ono bute than 12 mart cng neg ee My signature below is evidence that have read, understood and agreed tothe terms and cantons stated herein and have received a signed copy ofthe agreement. ‘STUDENT SoRaTURE at ToS PRESENTA aE srupet wate suRsAR. yeuwow van Texas Hazlewood Act Exemption Application wWwetp-ta Supporting Documentation Instructions Piceaiers To apply for the Texas Hazlewood Act Exemption, you must submit the following documents to your college or university: 1. The Hazlewood Exemption Application (completed and signed). For a tutorial on completing the appl http://www. tve.texas.gov/Hazlewood-Act.aspx. 2. Report of Separation or Discharge, DD Form 214 (and DD Form 215 if the DD Form 214 has been amended) - To verify the Veteran's place of entry, home of record at the time of entry, character of service, length of service, and dates of service. The copy you provide to your institution must be legible and contain the information listed above. tion, visit; ‘ADD Form 214 may be obtained from the National Archives: htto://Awww.archives.gov/veterans/military-service-records Hf the Veteran was discharged prior to January 1, 1950 previously used separation documents may be used. If the Veteran’s DD Form 214 was destroyed in the National Archives fire in 1973 or is otherwise unavailable, then the following documents may be used: * NA Form 13038, Certification of Military Service * Documentation from the National Archives that the Veteran's NA Form 13038 was sent in lieu of the DD Form 214 due to the DD Form 214 not being on file * Documentation that Veteran met the requirements of Subchapter B, Chapter 54, Texas Education Code for resident tuition on the date of entry into active duty indicated on the DD Form 214 3. Certificate of Eligibility for federal Gt Bill benefits — To verify eligibility for the Veteran's, or dependents federal education benefits. Certificates of eligibility may be obtained by completing an application on the Veterans Online Application (VONAPP) website at https://wwwebenefits.va.gov/ebenefits/vonapp. ‘* Ifthe Veteran's final discharge is prior to 9/11/2001 the certificate of eligibility is not required. 4. Ifthe Veteran died while in service: Report of Casualty, Form DD Form 1300 ~ To verify the Veteran's place of entry or home of record, and that his/her death was service related. 5. If the Veteran is deceased (not service connected) ~ Death Certificate for deceased Veteran for use in a Legacy transfer, 6. If the Veteran is totally disabled or individually unemployable due to military service-related illness or injury: You ‘must have a current (within one year) disability ratings decision letter from the VA indicating that rating, 7. If you are not the Veteran, Relationship Documentation ~ Submit one or more of the following documents to verify your relationship to the eligible Veteran. + Birth Certificate, or Marriage Certificate, or Adoption Papers, or Recent IRS Tax Transcript: hitos://www.irs.gov/individuals/get-transcriot. 8. Veterans must reside in the state of Texas during the term that the exemption will be used. * Children and spouse of eligible Veterans must be classified as a Texas resident by their institution. 9. Hazlewood Online Database Registration ~ To comply with the Federal Educational Rights and Privacy Act (FERPA) requirements, all applicants (Veteran and dependents) must register into the Hazlewood online database to use the Hazlewood Exemption at https://hazlewood.tve.texas.gov/students/. "TEXAS VETERANS COMMISSION Phone: 1-877-898-3833 or 512/463-3168 | TTV/TOD: Dial 711 | Fax 512/475-3832 | EMual Edueation@tveteras.gov | Web: wwrw ie texas gov ‘An Equal Opportunity Employer Texas Hazlewood Act Exemption ee Applica Ff, June 2016 Page Lot? For (Term) (year) at (Institution) “Submit this application to your college or university, not to the Texas Veterans Commission” Each Veteran, child, or spouse applying to receive an exemption through the Hazlewood Act, (Texas Education Code §54.341) must complete and sign this application and provide the institution with the documentation required to verify eligibility as indicated in this packet. Submit this application and all supporting documentation to your institution's Hazlewood Act Exemption administrator. 1am applying as (check only one): (Ja Veteran intending to use the Hazlewood Exemption (Complete Parts A, C, & D) {Ll child intending to receive a Legacy transfer of benefits (Complete Parts A-E) {Ja child of a totally disabled, service-related deceased, KIA, or MIA Veteran (Complete Parts A-D) (Ja spouse of a totally disabled, service-related deceased, KIA, or MIA Veteran (Complete Parts A-D) | am (check only one): {Lan applicant applying for the first time; or [D1 a previous Hazlewood recipient who has used __ hours at institution(s). Total prior hours used: Veteran___, Legacy (transferred hrs.)__, Spouse_, Child (w/own hrs.) Part A-Veteran’s Information Veteran's Name: Veteran’s SSN: Date of Birth: ___/__/_imyooyww} Veteran's Student ID# (if applicable): Address: - Phone Number: Email address: Part B— Other User Informatio) ere Relationship to Veteran: (CJ) Biological child Step-child Adopted child [[_J]IRS Dependent {{_]] Spouse Child's/Spouse’s Name: TaatName Tat name 7 Child's/Spouse's SSN: Date of Birth: ___/__/_(wmyoo/vvw) Child’s/Spouse’s Student ID# : (if applicable) Permanent Address: wer iy Tie Tip Code Email address: Phone Number: Part C—Loan Verification To qualify for the Hazlewood Exemption, the Veteran, child or spouse cannot be in default on a loan that is, made or guaranteed by the state of Texas. State loans can be viewed at http://www.hhloans.com/. ‘Does the Veteran, child or spouse have a loan through the Texas Higher Education Coordinating Board? (CO) Yes } No If yes, is the loan in default status? (Dyes (CO) No (1) Not Applicable TEAS VETERANS COMMISSION Phone: 187-898-3833 oF 312/463-3168 | TIV/TOO: Dil 722 | Fax: 512/875-3932 | [Mall Edueation@ve texas gov | Wels: ww. v6 tex Rov ‘An Equal Opportunity Employer Texas Hazlewood Act Exemption ie Application ne The Texas, up to 150 semester credit hours at public institutions of higher education in Texas. Except for recipients who are the spouse or children of eligible Veterans killed in action, missing in action, or whose death resulted from a service-related injury or illness; all other Hazlewood recipients meet the grade point average satisfactory academic progress requirements and other requirements of Texas Education Code §54.2001. | grant permission to any institution | have enrolled in or intend to enroll in to release credit hour information pertaining to my enrollment to the Texas Veterans Commission and the Texas Higher Education Coordinating Board, and further grant permission to the Commission and Board to share such information with any institution that | might attend. | certify that the information | have provided is true and correct to the best of my knowledge. | further understand that if | have provided inaccurate, incomplete, or untrue information on this application, | may be required to reimburse th itution for tuition, fees, and penalties pertaining to the Hazlewood Exemption. Veteran's Signature: Date: (Veteran's signature is not required ithe eligible Veteran is totally dlsabled, servce-related deceased, MIA, or KIA) Child’s/Spouse's Signature: Date: (if applicable) The Texas Hazlewood Exemption allows eligible Veterans or a designee to transfer all unused hours of the exemption, up to 150 semester credit hours, to a child who is 25 years old or younger on the first day of the term. Legacy recipients will receive an exemption for the number of degree certified hours associated with the specific degree or certificate program he or she is enrolled in consistent with the program length as defined in the school catalog as approved by the regional accreditation commission. Legacy recipients must meet the grade point average satisfactory academic progress requirements and other requirements of Texas Education Code §54.2001. Assigned hours may be revoked by the Veteran or the designee. | (Veteran) waive the right to all of the unused portion of my Hazlewood Exemption and grant permission to transfer those unused Hazlewood hours under Texas Education Code §54.341(k) (Legacy Act) to my eligible child, (child) . | agree to release current term and historic credit hour information to the Texas Veterans Commission and the Texas Higher Education Coordinating Board to determine the balance of my unused hours. | grant permission for the Commission and Board to share such data with any institution that my eligible child might attend. | understand that only one eligible person may use my hours for a particular term. | hereby certify the information | have provided is true and correct. | understand that if | fail to provide accurate information, | may be required to reimburse the institution and penalties may be imposed. Veteran's Signature. Date: * ifthe qualifying Veteran is deceased, the Veteran's Designee (Print Name) ‘may sign above in Veteran's place* Veteran's Child’s Signature: Date: “submit this application to your college or university, not to the Texas Veterans Commission* "TEXAS VETERANS COMMISSION Prone: 1-877-898-9839 or $12/469-3168 | TTY/TDO: Oial 711 | Fax: 512/475-3932 | E-Mail: Edvestion®tve texas gov | Webs wav texas. gov ‘An Equol Opportunity Employer Ge) Texas Hazlewood Act Exemption Initial Eligibility Requirements 3 For complete details go to the TVC website at http://www. tvc.texas.gov/Hazlewood-Act.aspx. Veterans 1. Entered the military service from Texas, pr'Home of Record at the time of entr resident atjthe time of entry into military service Served more than'180 days of federal military services ~ Excluding Basic Training Received an Honorable Discharge or General Discharge under Honorable Condi Exhausted GI ill benefits if eligible for Post 9/11 GI Bill benefits at the 100% rate Reside in Texas during term of enrollment Provide DD 214 or equivalent supporting documentation Texas, or was a Texas ns anewn Legacy ~ transfer of Hazlewood benefit to a child Veteran must qualify for the Hazlewood Exemption Provide death certificate if veteran is deceased . Recipient must be the biological child, stepchild, adopted child, or claimed as dependent for current or previous tax year on IRS 1040 Recipient must be 25 Years old or younger on first day of class Recipient must enroll in a degree or certificate program and maintain satisfactory academic progress Recipient must meet the institution's resident tuition requirements Provide DD 244 or equivalent supporting documentation Noyes Child or Spouse — child and spouse of a totally and permanently disabled or individually unemployable veteran Veteran must qualify for the Hazlewood Exemption Veteran’s disability must be verified by a current VA disability rating letter Recipient must be a dependent of a qualifying veteran Recipient must meet federal financial aid SAP (satisfactory academic progress) requirements Recipient must meet the institution's resident tuition requirements Provide DD 214 or equivalent supporting documentation one eN Child or Spouse ~ child and spouse of a service-related deceased, missing in action, or killed in action veteran Veteran must meet Hazlewood Exemption eligibility criteria Reci nt must meet the institution's resident tuition requirements Provide DD 1300 Report of Casualty form Provide DD 214 if veteran's service-related death was after being discharged Pee VC Form HAEJER, rev. 06/2014 Texas Hazlewood Act Exemption Application For Continued Enrollment * For (term) (year) SUBMIT THIS APPLICATION TO YOUR COLLEGE OR UNIVERSITY Student's Name: _ Last Name First Name I Social Security Number: Student's schoo! ID Number: Date of Birth, I. Address: Street city State Zip Code Phone Number Email address To qualify for the Hazlewood Exemption the veteran, child, or spouse cannot be in default on a loan that is made or guaranteed by the state of Texas. State loans can be viewed at http://www.hhloans.com/ Does the veteran, child, or spouse have a loan through the Texas Higher Education Coordinating Board? (1 Yes (1 No If yes, is the loan in default status? [1 Yes [1 No | am applying for continuation of the exemption from payment of tuition and fees under Texas Education Code §54.341, (The Hazlewood Act). | understand that | may be entitled, under the law, to this exemption for up to 150 semester credit hours at Texas public institutions of higher education. For the purpose of accounting for the total number of hours for which | receive this exemption, I grant permission to any institution in which | have enrolled or will enroll to release credit hour information to the Texas Veterans Commission and grant permission for TVC to share such information with any institution that | might attend, have previously used hours under the Texas Hazlewood Act Exemption Signature: Date: * This form will not be used for initial application for the Hazlewood Exemption, but may be used for enrollment of students subsequent to initial enrollment at the school in which the student is currently and consistently enrolled. if a break in enrollment or change of school occurs then the complete Hazlewood Exemption application must be completed. ‘TVC Form HAE-App-CE, rev. 06/2014 To: Business Office HAZLEWOOD VOUCHER From: Veterans Affairs Office- ‘snd an File in this office. Name = Banner Ud {certify that the document(s) verified are true and correct. ‘Cauoriss Credit: HAZLEWOOD LEGACY HAZLEWOOD ORPH DEP HAZLEWOOD SPOUSE HAZLEWOOD (VET/DEP) Continuing Education: HAZLEWOOD SPOUSE -CE HAZLEWOOD 2.CE HAZLEWOOD ORPH 2 DEP-CE. ‘To: Business Office Prom: Veterans Affairs Office- ‘College ‘Semester: 34203 54.203, 34.203, 54203 0) 34.208 54.203 (a) 54.205 (0) ° Following individual meets the requirements to enroll for the semester under the HAZLEWOOD ACT. The students file is vmplete Hours Approved: HAZLEWOOD VOUCHER Tallege The following individual meets the requirements to enroll forthe semester under the HAZLEWOOD ACT. The student's file is complete snd on file in this office. Name: Banner td {certify tht the document(s) verified are true nnd correct. Catena Cel: UAZLEWOOD LEGACY. HAZLEWOOD ORPH DEP HNZLEWOOD SPOUSE. HAZLEWOOD (VETDEP) ‘Continuing Education: HAZLEWOOD SPOUSE -CE HAZLEWOOD 2-CB MAZLEWOOD ORPH 2 DEP-CE Semester: 54.205 (6) M2 54.2030) 54.203 (0) | Business Olfine Use 8000274 8000378,

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