Fillable 2022-23 TUITION ASSISTANCE GRANT PROGRAM APPLICATION (Liberty University)

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2022-23 TUITION ASSISTANCE GRANT PROGRAM APPLICATION (Liberty University)

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Student’s Name (please print) College Issued Student ID Number
2022-23 TUITION ASSISTANCE GRANT PROGRAM APPLICATION
— IMPORT
ANT INFORMATION FOR STUDENTS AND PARENTS —
This document contains important information for all students par ticipating in the Virginia Tuition Assistance Grant (VTAG) program
administered by the institutions and the State Council of Higher Education for V irginia (SCHEV). It also provides details on the eligibility
requirements, application deadlines, and criteria for award distributions. Please read this document carefully.
BACKGROUND INFORMATION
The Commonwealth of Virginia provides VTAG as a non need-based grant for V irginia residents attending a participating Virginia private
college or university. While the maximum award is authorized each biennium, the amount is not guaranteed and can vary annually. The
amount of each academic year’s award is determined by the available funding and the total number of eligible applicants. If funding is
insuf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 of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 specified in this application. The basic eligibility requirements are:
• Domiciled resident of V irginia for at least one year prior to receiving VTAG or a dependent of eligible military personnel.
• 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 financial aid office.
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 fiscal year. This categor y 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,
2022. This categor y 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, 2022.
• 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, 2022.
After the March verication of actual spring term enrollments, SCHEV will determine the nal award amounts for categor y 1 and 2 applicants.
If necessary, the spring amount will be adjusted. Awards, if any, for categor y 3 and 4 applicants cannot be determined until mid-spring.
ADDITIONAL INFORMATION
Total suppor t 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 year s. 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 nancial aid oce. ***
COLLEGES AND UNIVERSITIES APPROVED FOR PARTICIPATION
Appalachian College of Pharmacy Edward Via Virginia College of Hampden-Sydney College Randolph College Sweet Briar College
Averett University Osteopathic Medicine Hampton University Randolph-Macon College University of Lynchburg
Blueeld College Emory & Henry College Hollins University Regent University University of Richmond
Bridgewater College Ferrum College Liberty University Roanoke College Virginia Union University
Christendom College George Washington University Mary Baldwin University Shenandoah 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 cer tified by a 51 series CIP code -- are eligible to receive VTAG.
State Council of Higher Education for Virginia 1 of 4 Update 09/21
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.
Yes
Female
No
Yes No
Yes No
Yes No
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 2022, will you have earned a baccalaureate degree (i.e., B.A., B.S., etc)?
12. By August 202
2, 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 2022-23 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
Veteran or active-duty member of the U.S. Armed Forces
Ward of the court or was a ward of the court until age 18
Have legal dependents other than spouse
Post-baccalaureate student
Both parents are deceased, no adoptive or
legal guardians
State Council of Higher Education for Virginia 2 of 4 Update 09/21
Priority Application Deadline: July 31, 2022
Print and submit the completed VTAG application to your institution’s financial aid office.
Virginia Tuition Assistance Grant Application
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 por tion 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.”
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?
19 A. Will (or did) you file a 2021 Virginia full- or part-year resident income
tax form?
Yes No
B. If “No,” were taxes paid to:
Another State
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
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
Parent/Legal Guardian/
Spouse
Yes No
Another State
Not Employed
Yes No
Another State
Did Not File
Yes No
Another State
Not Registered
Yes No
Another State
Not Licensed
22 A. Do you operate a motor vehicle registered in Virginia?
Yes
No Yes No
B. If “No,” is it registered in:
Another State Another State
Do Not Own Do Not Own
or Operate or Operate
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
Yes
No
Virginia withholding?
Eective date of change to Virginia: ____ / ____ / ____
Attach a copy of your most recent LES.
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 09/21
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
Work: (_____) ______ - _________ Home: (_____) ______ - _________
telephone numbers
27. Is your parent/legal guardian/spouse a U.S. Citizen or Permanent Resident?
Yes No
If “No,” some classifications and visas permit the person to establish domicile. For more information on which documents permit
domicile, see Addendum A of the Domicile Guidelines. Attach copy of this INS documentation.
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. 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. Indicate your enrollment plans: (Check one).
Enroll for both semester s (fall and spring) Enroll for only one semester (check one): Spring Fall
NOTE: Notify your nancial aid ofcer if you are a dependent of an active-duty militar y member who is not claiming Virginia domicile and they
will determine if you are eligible for VTAG under the militar y dependent provision.
SECTION E: Cer tification 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 suppor ting 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
PRINT THIS FORM
Signature of Parent/Legal Guardian/Spouse Referenced in Section C Above
(If required to furnish parental or spousal information)
Date
Priority Application Deadline: July 31, 2022
Completed Applications Should Be Submitted To Your Institution’s Financial Aid Office.
State Council of Higher Education for Virginia 4 of 4 Update 09/21
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2022-23 TUITION ASSISTANCE GRANT PROGRAM APPLICATION (Liberty University)

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Completed 22 December 2021

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