Fillable 2020-21 TUITION ASSISTANCE GRANT PROGRAM APPLICATION (Averett College)

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2020-21 TUITION ASSISTANCE GRANT PROGRAM APPLICATION (Averett College)

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Student’s Name (please print) College Issued Student ID Number
2020-21 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, applica-
tion 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 insufficient to fully award all students, it is possible that the spring award will be adjusted and late applicants will
receive no award. The college financial aid office will have the most current information about the expected maximum award. See below for the
catego-ries 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 VT
AG 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 specifics on “full-time” or “eligible degree program,” please contact your institution’s financial aid office.]
• A completed VTAG application submitted to your institution’s nancial aid ofce.
• Beginning fall 2020, new and former students enrolled in an online education or distance learning program are not eligible to receive a
VTAG award. However, students enrolled in online education or distance learning programs during 2019-20 academic year shall remain
eligible to receive awards pursuant to current eligibility criteria.
APPLICATION DEADLINES AND AWARD DISTRIBUTION CRITERIA
Conditions for reduction of the award amount and eligibility are described in program regulations. If funds are not suf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 subsequent 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 scal year. This category includes transfer students who received
a VTAG award in the previous scal 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,
2020. This category also includes returning and transfer students determined to be eligible in the previous scal 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, 2020.
• Category 4: All students eligible for spring term awards only (except those who received the award in the previous scal year), and who apply
by December 1, 2020.
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 and no more than four years for eligible undergraduate programs and post-
undergraduate programs in medicine and pharmacy. Recipients of the awards have the responsibility 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.
*** If you have further questions regarding VTAG, please contact your institution’s financial aid office. ***
COLLEGES AND UNIVERSITIES APPROVED FOR PARTICIPATION
Appalachian College of Pharmacy Edward Via Virginia College of Hampden-Sydney College Randolph College
Averett University Osteopathic Medicine Hampton University Randolph-Macon College
Blueeld College Emory & Henry College Hollins University Regent University
Bridgewater College Ferrum College Liberty University Roanoke College
Christendom College George Washington University Mary Baldwin University Shenandoah University
Sweet Briar College
University of Lynchburg
University of Richmond
Virginia Union University
Virginia Wesleyan College
Eastern Mennonite University (VA campus only) Marymount University Southern Virginia University Washington & Lee University
Graduate Students: As of July 1, 2009, 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 5 Update 06/20
Virginia Tuition Assistance Grant Application
Priority Application Deadline: July 31, 2020
Print and submit the completed VTAG application to your institution’s financial aid office.
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 ZIP code
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
a. ____ / ____ / ____ to today ________________________________________ _____________________ _____ _______
b. ____ / ____ / ____ to ____ / ____ / ____ ________________________________________ _____________________ _____ _______
c. ____ / ____ / ____ to ____ / ____ / ____ ________________________________________ _____________________ _____ _______
8. Are you a United States Citizen or Permanent Resident? Yes No
If “No,” attach a copy of your INS documentation to this application, indicating your classication and expiration date.
9. If you are male, have you complied with the U.S. Selective Service registration requirement?
Yes No
Female
10. Have you received a VTAG award before? Yes No
If “Yes,” in what year(s) did you receive the award? ___________________________________
At which institution(s)? _____________________________________________________________
11. By August 2020, will you have earned a baccalaureate degree (i.e., B.A., B.S., etc)? Yes No
12. By August 2020, will you have earned a post-baccalaureate degree (i.e., M.A., J.D., etc)? Yes No
13 A. What will be your level of study during the 2020-21 academic year? (Check only one)
Undergraduate Graduate (health professions) Medicine (not pre-med) and Pharmacy
B. Will this be your rst term at this level? Yes No
14. Did your parents/legal guardian provide 50% or more of your nancial 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
State Council of Higher Education for Virginia 2 of 5 Update 06/20
Priority Application Deadline: July 31, 2020
Completed Applications Should Be Submitted To Your Institution’s Financial Aid Office.
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.
17. You are completing the boxed areas for your: (Check only one) Father Mother Legal Guardian Spouse
For questions 18 - 22, you must answer question “B” if your response to question “A” is “No.”
To be completed by student
18. A. Have you been employed in Virginia in the past year? Yes No
B. If “No,” were you employed in: Another State Not Employed
C. If you answered “Not Employed” under “Student,” what are your source(s) of nancial support?
18. A. Have you been employed in Virginia in the past year? Yes No
B. If “No,” were you employed in: Another State Not Employed
C. If you answered “Not Employed” under “Student,” what are your source(s) of nancial support?
19. A. Will (Or did) you le a 2019 Virginia full- or part-year resident income tax form? Yes No
B. If “No,” were you taxes paid to: Another State Not Employed Did Not File
19. A. Will (Or did) you le a 2019 Virginia full- or part-year resident income tax form? Yes No
B. If “No,” were you taxes paid to: Another State Not Employed Did Not File
20. A. Are you a registered voter in Virginia? Yes No
B. If “No,” are you registered to vote in: Another State Not Registered
20. A. Are you a registered voter in Virginia? Yes No
B. If “No,” are you registered to vote in: Another State Not Registered
21. A. Do you hold a valid Virginia driver’s license? Yes No
B. If “No,” do you hold a license in: Another State Not Licensed
21. A. Do you hold a valid Virginia driver’s license? Yes No
B. If “No,” do you hold a license in: Another State Not Licensed
22. A. Do you operate a motor vehicle registered in Virginia? Yes No
B. If “No,” is it registered in: Another State Do Not Own or Operate
22. A. Do you operate a motor vehicle registered in Virginia? Yes No
B. If “No,” is it registered in: Another State Do Not Own or Operate
Priority Application Deadline: July 31, 2020
Completed Applications Should Be Submitted To Your Institution’s Financial Aid Office.
State Council of Higher Education for Virginia 3 of 5 Update 06/20
23. A. Are you an active-duty member of the U.S. Armed Forces? Yes No
B. If “Yes” does your military Leave and Earnings Statement (LES) reect Virginia withholding?
Effective date of change to Virginia ____/ ______/ ______
Attach a copy of your most recent LES.
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
Effective date of change to Virginia ____/ ______/ ______
Attach a copy of your most recent LES.
SECTION C: Parent/Legal Guardian/Spouse Information
25. Name of parent/legal guardian/spouse: ______________________________________________________________________________
(Based on your answer to Question 17) 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, and residing under a classification legally eligible to establish domicile, attach a copy of the INS documentation, including the
classification and expiration date, to this application. If there is uncertainty on how to answer this question, leave this question blank
and contact the financial aid office directly.
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
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. A. Student’s Education History
School/College Name State Start Date (MM/YY) End Date (MM/YY)
High School /
Undergraduate / /
Undergraduate / /
Graduate / /
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. A. Indicate your enrollment plans: (Check one).
Enroll for both semesters (fall and spring) Enroll for only one semester (check one): Spring Fall
NOTE: Notify your financial aid officer 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.
State Council of Higher Education for Virginia 4 of 5 Update 06/20
Priority Application Deadline: July 31, 2020
Completed Applications Should Be Submitted To Your Institution’s Financial Aid Office.
SECTION E: Certification 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 application, 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
(If required to furnish parental or spousal information)
Date
PRINT THIS FORM
State Council of Higher Education for Virginia 5 of 5 Update 06/20
Priority Application Deadline: July 31, 2020
Completed Applications Should Be Submitted To Your Institution’s Financial Aid Office.
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2020-21 TUITION ASSISTANCE GRANT PROGRAM APPLICATION (Averett College)

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