AB13 (VACA) Affidavit for Eligible Veterans
California Nonresident Tuition Exemption Request
Please type or use a black or dark blue pen.
The student must complete and submit this form and provide proof of eligibility via ‘Certificate of Eligibility’ and ‘DD214’
I declare the following, under penalty of perjury: I, , am a veteran or
dependent (spouse or child) who qualifies for an exemption from nonresident fees under Section 702 of VACA.
The student must read and initial each statement below:
________ I understand that I must be physically present in California in order to qualify for this exemption.
________ I understand that I must enroll at Allan Hancock 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 a print out
of the veteran’s eBenefits verifying entitlement information
and
DD214 of the veteran
Print Full Name (as it appears on your college student records)
AHC Student Identification Number
H __ __ __ __ __ __ __ __
Print Full Mailing Address (number, street, city, state, zip)
myHancock email address:
___________________________@my.hancockcollege.edu
Phone Number:
For Office Use Only
Veteran Discharge Date: ____________________ Residency Status Updated: ___________________
Cert of Elig.& DD214: ____________________
Received by: ________________________
Staff Member initials and date
This form may be submitted in person to the Admissions and Records or sent electronically to
jcabanas@hancockcollege.edu
click to sign
signature
click to edit
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