Fillable 2019-20 TUITION ASSISTANCE GRANT PROGRAM APPLICATION (Eastern Mennonite University)

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2019-20 TUITION ASSISTANCE GRANT PROGRAM APPLICATION (Eastern Mennonite University)

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Student’s Name (please print) CollegeIssuedStudentIDNumber
2019-20 TUITION ASSISTANCE GRANT PROGRAM APPLICATION
— IMPORTANT INFORMATION FOR STUDENTS AND PARENTS —
This document contains important information for all students participating in the Virginia Tuition Assistance Grant (VTAG) program administered by the
institutions and the State Council of Higher Education for Virginia (SCHEV). It also provides details on the eligibility requirements, application deadlines,
and criteria for award distributions. Please read this document carefully.
BACKGROUND INFORMATION
VTAG is a non need-based grant for Virginia residents attending a participating Virginia private college or university. Funds for this grant have been
appropriated by the state legislature since 1973. While the maximum award is authorized each biennium, the amount is not guaranteed and can vary
annually. The exact amount of each academic year’s award is determined by the available funding and the total number of eligible applicants. If funding
is insucient to fully award all students, it is possible that the spring award will be adjusted and some students will receive no award. The college nancial
aid oce will have the most current information about the expected maximum award. See below for the categories and prioritization of awards.
ELIGIBILITY REQUIREMENTS
Students must meet all the eligibility requirements set forth by the General Assembly, Sections 23.1-628 through 635 of the Code of Virginia and in the
VTAG regulations, 8 VAC 40-71. All requirements are not specied in this application. The basic eligibility requirements are:
• Domiciled resident of Virginia for at least one year prior to receiving VTAG or dependent of certain military personnel.
[A student who is in Virginia primarily to attend college is not considered to be a domiciled resident.]
• Enrolled as a full-time student at an eligible institution in an eligible degree program.
[For specics on “full-time” or “eligible degree program,” please contact your institution’s nancial aid oce.]
• A completed VTAG application submitted to your institution’s nancial aid oce.
APPLICATION DEADLINES AND AWARD DISTRIBUTION CRITERIA
Conditions for reduction of the award amount and eligibility are described in program regulations. If funds are not sucient to make full VTAG awards to
all eligible students, a priority system is used to determine the size of the awards. Students in the rst categories must receive full funding before subse-
quent categories can be considered; however, categories 1 and 2 are combined and will receive the same award amount.
Priority System:
• Category 1: Returning students who received a VTAG award in the previous fiscal year. This category includes transfer students who received
a VTAG award in the previous fiscal year at another institution.
• Category 2: New and re-admit students who are eligible for fall or fall and spring term awards and who apply for the VTAG program by July
31, 2019. This category also includes returning and transfer students determined to be eligible in the previous fiscal year, but not awarded.
• Category 3: New and re-admit students who are eligible for fall or fall and spring term awards and who apply for the VTAG program between
and including August 1 and September 14, 2019.
• Category 4: All students eligible for spring term awards only (except those who received the award in the previous fiscal year), and who
apply by December 1, 2019.
After the March verication of actual spring term enrollments, SCHEV will determine the nal award amounts for category 1 and 2 applicants.
If necessary, the spring amount will be adjusted. Awards, if any, for category 3 and 4 applicants cannot be determined until mid-spring.
ADDITIONAL INFORMATION
Total support cannot exceed two years for an associate program, no more than four years for undergraduate programs, and no more than three years for
all post-undergraduate programs except for medicine and pharmacy, which allow a maximum of four years. Recipients of the awards have the responsi-
bility to notify, in writing, the institutions they attend of any name or permanent address changes.
The institutions and SCHEV do not discriminate on the basis of race, color, national origin, sex, religion, age, or disability when making award decisions
or reviewing appeals; any information requested for these items is for statistical purposes only.
Public Law 93-579, referred to as the Federal Privacy Act, requires that any federal, state, or local agency that requests an individual to disclose his Social
Security number inform the individual by which statutory or other authority the number is solicited, whether that disclosure is mandatory or voluntary,
and what uses could be made of it. SCHEV, as required by published regulations, requests each applicant for its student aid programs to submit a Social
Security number on a voluntary basis. The Council uses a student’s Social Security number for unique identication purposes in the application and
reporting processes.
*** If you have further questions regarding VTAG, please contact your institution’s nancial aid oce. ***
COLLEGES AND UNIVERSITIES APPROVED FOR PARTICIPATION
Appalachian College of Pharmacy Edward Via Virginia College of Hampton University Randolph College
Averett University Osteopathic Medicine Hollins University Randolph-Macon College
Blueeld College Emory & Henry College Jeerson College of Health Sciences Regent University
Bridgewater College Ferrum College Liberty University Roanoke College
Christendom College George Washington University Shenandoah University
Eastern Mennonite University (VA campus only)
Mary Baldwin University
Southern Virginia University
University of Lynchburg
University of Richmond
Virginia Union University
Virginia Wesleyan College
Washington & Lee University
Hampden-Sydney College
Marymount University
Sweet Briar College
Graduate Students: Only students enrolled in graduate programs in the health professions -- as certified by a 51 series CIP code -- are eligible to receive VTAG.
State Council of Higher Education for Virginia 1 of 4 Update 10/18
________________________________ __________________ ___ ______________
________________________________ __________________ ___ ______________
___ ______________


Virginia Tuition Assistance Grant Application
Initial Application Deadline: July 31, 2019
Print and submit the completed VT
AG application to your institution’s nancial aid oce.
SECTION A: Student Information
Please type or print in ink. Be sure to read all directions carefully. THE PROCESSING OF YOUR APPLICATION WILL BE DELAYED UNLESS ALL
PAGES ARE COMPLETED, AND THE APPLICATION IS SIGNED AND DATED.
1. Name: ______________________________________ __________________________________________ ___________________
Last First Middle Initial
2. Social Security Number: XXX -XX - ____ ____ ____ ____ 3. Date of Birth: _____ / _____/ _______
4. Sex: M F 5 A. Phone: (______) _________- ____________ 5 B. Email: ________________________________________
6. Permanent address: ___________________________________________________________________________________________
[ NO P.O. BOX ]
Street City State
7. Where have you lived in the last two years? List current address rst. Dates must be included.
From (MM/DD/YY) To (MM/DD/YY) Street City State
ZIP code
ZIP code
a. ____ / ____ / ____ to today
b. ____ / ____ / ____ to ____ / ____ / ____
c. ____ / ____ / ____ to ____ / ____ / ____ ________________________________ __________________
Yes
Yes
Female
No
No
Yes No
Yes No
Yes No
Undergraduate Graduate (health professions) Medicine (not pre-med) and Pharmacy
Yes No
8. Are you a United States Citizen or Permanent Resident?
If “No,” attach a copy of your INS documentation to this application, indicating your classification and expiration date.
9. If you are male, have you complied with the U.S. Selective Service registration requirement?
10. Have you received a VTAG award before?
If “Yes,” in what year(s) did you receive the award? ___________________________________
At which institution(s)? _____________________________________________________________
11. By August 2019, will you have earned a baccalaureate degree (i.e., B.A., B.S., etc)?
12. By August 2019, will you have earned a post-baccalaureate degree (i.e., M.A., J.D., etc)?
13 A. What will be your level of study during the 2019-20 academic year? (Check only one)
B. Will this be your first term at this level?
13. Did your parents/legal guardian provide 50% or more of your financial support or claim you as
a tax dependent during the past year?
Yes No
15 A. Do you wish to claim eligibility for VTAG based on your spouse’s domicile?
Yes No
Not Married
B. If “Yes,” does your spouse provide over 50% of your nancial support? Yes No
16. Do any of the following characteristics apply to you? (Place a check mark beside all that apply)
Age 24 or older as of the rst day of the term in which you plan to enroll Have legal dependents other than spouse
Veteran or active-duty member of the U.S. Armed Forces
Post-baccalaureate student
Ward of the court or was a ward of the court until age 18
Both parents are deceased, no adoptive or legal
guardians
Completed Applications Should Be Submitted To Your Institution’s Financial Aid Office.
State Council of Higher Education for Virginia 2 of 4 Update 10/18
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 
 
17. You are completing the boxed areas for your: (Check only one) Father Mother Legal Guardian Spouse
SECTION B: Domicile Information
If you did not check any of the characteristics in Question 16, or if you answered “Yes” to Question 15 B, complete both the
“Student” (unboxed) and “Parent/Legal Guardian/Spouse” (boxed) areas in Sections B, C, and E. In response to Question 17, indicate
whether you are providing your parent, legal guardian, or spouse’s information in the boxed sections.
If you did check any of the characteristics in Question 16, complete only the “Student” (unboxed) areas of this application.
IMPORTANT: If you complete the portion of this application that is boxed with parental information, answer the questions based on
the parent/legal guardian from whom you received the most nancial support. You may also choose to provide information about a
spouse. That person also must sign and date this application.
For questions 18 - 22, you must answer question “B” if your response to question “A” is “No.”
Student Parent/Legal Guardian/
Spouse
18 A. Have you been employed in Virginia in the past year?
Yes No Yes No
B. If “No,” were you employed in:
C. If you answered “Not Employed” under “Student,” what are your
source(s) of nancial support?
Another State
Not Employed
Another State
Not Employed
Yes No
Another State
Did Not F
ile
Yes No
Another State
Not Registered
Yes No
Another State
Not Licensed
Yes No
Another State
Do Not Own or
Operate
19
A. Will (or did) you file a 2018 Virginia full- or part-year resident income
tax form?
B. If “No,” were taxes paid to:
20 A. Are you a registered voter in Virginia?
B. If “No,” are you registered to vote in:
21 A. Do you hold a valid Virginia driver’s license?
B. If “No,” do you hold a license in:
22 A. Do you operate a motor vehicle registered in Virginia?
B. If “No,” is it registered in:
23 A. Are you an active-duty member of the U.S. Armed Forces?
B. If “Yes,” does your military Leave and Earnings Statement (LES) reect
Virginia withholding?
Eective date of change to Virginia: ____ / ____ / ____
Attach a copy of your most recent LES.
Yes No
Another State
Did Not File
Yes No
Another State
Not Registered
Yes No
Another State
Not Licensed
Yes No
Another State
Do Not Own or
Operate
Yes No
Yes No
24 A. Is your parent/legal guardian/spouse an active-duty member of the U.S. Armed Forces?
Yes No
B. If “Yes,” does his or her military Leave and Earnings Statement (LES) reect Virginia withholding?
Yes No
Eective date of change to Virginia: ____ / ____ / ____
Attach a copy of his or her most recent LES.
Completed Applications Should Be Submitted To Your Institution’s Financial Aid Office.
State Council of Higher Education for Virginia 3 of 4 Update 10/18
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SECTION C: Parent/Legal Guardian/Spouse Information
25. Name of parent/legal guardian/spouse: ______________________________________________________________________
Last First Middle Initial
26. Parent /legal guardian or spouse’s
telephone numbers
Work: (_____) ______ - _________ Home: (_____) ______ - _________
27.
Is your
parent/legal guardian/spouse a U.S. Citizen or Permanent Resident?
Yes No
If “No,” attach a copy of his or her INS documentation, including the classification and expiration date, to this application.
If your parent is not domiciled in Virginia, check with the institution to determine whether you can use your own domicile.
28. Where has your parent/legal guardian/spouse lived in the last two years? List current address rst. Dates must be included.
From (MM/DD/YY) To (MM/DD/YY) Street City State ZIP code
a. ____ / ____ / ____ to today _____________________________ ________________ _______ ____________
b. ____ / ____ / ____ to ____ / ____ / ____ _____________________________ ________________ _______ ____________
c. ____ / ____ / ____ to ____ / ____ / ____ _____________________________ ________________ _______ ____________
SECTION D: Additional Information
(Based on your answer to Question 17)
29 A. Have you always resided in Virginia?
Yes No
B. If “No,” when did you most recently move to Virginia? _____ / _____ / _______
MM DD YY
30. When did you begin or when will you begin attending college at a Virginia institution?
(If you attended a Virginia college as an undergraduate and a graduate, please answer both)
Undergraduate ____ / _____ / _____ Which college? ______________________________________
MM DD YY
Graduate ____ / _____ / _____ Which college? ______________________________________
MM DD YY
31. A. If you answered “No” to Question 29, did you move to Virginia in order for
you or a member of your family to attend college? Yes No
B.
If “No, “ indicate reason for move: ____________________________________________________________________________
32. Indicate your enrollment plans: (Check one.)
Enroll for both semesters (fall and spring)
Enroll for only one semester (check one):
Fall Spring
NOTE: Notify your nancial aid ocer if you are a dependent of an active-duty military member who is not claiming Virginia
domicile and they will determine if you are eligible for VTAG under the military dependent provision.
PRINT THIS FORM
SECTION E: Certication and Signature(s)
33. I certify that the information I have provided is true. I agree to furnish the college or university and SCHEV with supporting documentation related to this applica-
tion, if requested to do so. I authorize the college to act as my scal agent for receipt of state funds; to act as SCHEV’s agent for the administration of this program,
and to release requested nancial aid and admission information to SCHEV and other VTAG participating institutions expressly for purposes of administration of
this program. I agree to notify the college or university (immediately) of any name or permanent address changes. I agree to allow SCHEV to have access to my
Department of Motor Vehicle and Department of Taxation records.
___________________________________________________________________ _____ / _____ / _______
Signature of Applicant Date
___________________________________________________________________
Signature of Parent/Legal Guardian/Spouse Referenced in Section C Above
_____ / _____ / _______
Date
(If required to furnish parental or spousal information)
Priority Application Deadline: July 31, 2019
Completed Applications Should Be Submitted To Your Institution’s Financial Aid Office.
State Council of Higher Education for Virginia 4 of 4 Update 10/18
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2019-20 TUITION ASSISTANCE GRANT PROGRAM APPLICATION (Eastern Mennonite University)

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