Evergr
een Valley College
AB13 (VACA) Affidavit for Eligible Veterans
California Nonresident Tuition Exemption Request
Dear EVC VA Student,
Complete this form, submit and provide a proof of eligibility (‘Certificate of Eligibility’ orDD214’) to Tiffani Lam, EVC Office of
Admission and Records
I declar
e the following, under penalty of perjury:
I, ___ , am a Military personnel or dependent (spouse or child)
Student Name
who qualifies for an exemption from nonresident fees under Section 702 of VACA.
I understand that I must be physically present in California in order to qualify for this exemption.
I understand that I must enroll at Evergreen Valley College within 3 years of my discharge date (or the
discharge date of the member in cases of dependents) in order to qualify for this exemption.
I understand that I must have served at least 90 days in active duty status (or in the case of
dependents, the member must have served at least 90 days in active duty status).
I understand that I must provide proof of eligibility via: (attach documentation)
- Certificate of Eligibility of student showing eligibility for Montgomery GI Bill Active Duty or
Post-911 GI Bill education benefit programs (Chapters 30 or 33, respectively, to Title 38, U.S. Code)
or,
- DD214 (this option does not apply to spouse or child, only the Member).
Print Full Name (as it appears on your college student records)
Student Identification Number (Student ID)
Print Full Mailing Address (number, street, city, state, zip)
Email address: (optional)
Phone Number: (optional)
Signature:
Date:
For Office Use Only
Member Discharge Date:
Received by:
Cert of Elig. or DD214:
Print Name
90 days Active Duty:
Received Date:
Coded AB13:
click to sign
signature
click to edit
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