Fillable Application Instructions for TN STRONG Act (University of Tennessee, Knoxville)

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Application Instructions for TN STRONG Act (University of Tennessee, Knoxville)

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Application Instructions for
TN STRONG Act
***Check with your post-secondary institutions for any deferment deadlines!***
***Incomplete/illegible applications will be returned without action!***
Follow detailed instructions regarding each item as follows:
1. TN STRONG Act tuition reimbursement Application Form:
Section I - Members Information: Complete in full, blocks 1-16 as required.
Block 15: Used to validate member’s eligibility for Federal Tuition Assistance (FTA) and
is a serving member during the school semester.
Section II- Members Waiver & Certification - Read statement, sign and date as required.
***ONLY DOD CAC or Hand-written signatures will be accepted****
Section III- Unit/Squadron Commander: Submit your application packet to your
Commander for review. Commander will recommend or non- recommend, sign and date.
If non-recommended, Commander is required to provide a letter outlining reasons.
Include letter in application packet.
Section IV- Enrollment Certification: Take to certifying official at postsecondary
institution to complete and verify classes and costs!
Section V- State TA Manager (STA) Review: Completed by State Tuition Assistance
Manager once complete application is submitted to respective branch STA.
2. TN STRONG Act tuition reimbursement Statement of Understanding (SOU):
Applicants must read and initial each paragraph, sign and date as required.
This is legal acknowledgment for record and is considered supporting documentation.
3. TN STRONG Act Tuition Reimbursement Authorization for Release Form:
Print member name and last 4 of SSN. Read statements, initial each paragraph, complete
postsecondary institution information, sign and date as required. *The postsecondary
institution version of FERPA will be accepted.*
Once application request is complete, scan all documents as PDF file and email to either Air or
Army mailboxes or use contact info for question
relevant to your branch of service
Air Contact: MSGT Joseph Wilson - Comm: (615) 313-0849; DSN: 683-0849
ng.tn.tnarng.mbx.ngtn-state-tuition-assistance-air@army.mil
Army Contact: SFC Stephen Biase - Comm: (615) 313-0737; DSN: 683-0737
ng.tn.tnarng.mbx.ngtn-state-tuition-assistance-army@army.mil
Pag
e 1 of 5
Revised: 01 November 2021
Tennessee National Guard STRONG Act Program
Tuition Reimbursement
Request
“This document contains information exempt from mandatory disclosure under the FOIA. Exemption 5 U.S.C.
553(b) (6) applies. This document also contains personal information that is protected by the Privacy Act of 1974
and must be safeguarded from unauthorized disclosure”
SECTION I – MEMBER’S INFORMATION
1. Member’s Name (Last, First, MI):
2.Gender(M/F)
3. Date of Birth
(YYYYMMDD)
4.Rank/Grade
5. SSN:
6. Permanent Home Address:
8. State:
9. Zip Code:
10. Phone Number (Home, Cell, Work)
11. Valid Email Address (Work, Civilian, Military)
12. Unit of Assignment & Location:
132a. Branch Of Service: ☐ Air Guard ☐ Army Guard
13b. Duty Status: ☐ Traditional ☐ Active Guard Reserve(AGR)
14. Current Education Path:
☐ Certif
ication ☐ Associate’s Degree
☐
Bachelor’s Degree
☐
Master’s Degree
(YYYYMMDD)
16. ETS Date:
(YYYYMMDD)
SECTION II – MEMBERS WAIVER & CERTIFICATION
By signing this form, I agree to have my transcript, itemized bill and withdrawal information released to the
TNG JFHQ A-1/JFHQ G-1. I understand that my acceptance for the STRONG Act tuition reimbursement
program is based upon availability of funding. I have carefully read the attached Statement of Understanding and
will abide by the stipulations within.
Member’s Signature:
Date Signed (YYYYMMDD):
SECTION III – UNIT/SQUADRON COMMANDER
I certify that the Member is a satisfactory participant in good standing with less than 9 unexcused absences
from UTAs within any 12 month period with my respective unit as prescribed in AR 135-91, AR 350-1, or AFI
36-3209. Further I certify that he/she meets the eligibility criteria outlined in Rule 0930-02-01 of the
guidelines for the STRONG Act Program.
☐
Recommend
☐
Non-Recommend
Commander’s Printed Name: Commanders’s Signature:
Date Signed (YYYYMMDD)
________
_________________________ _________________________________
Page 2 of 5
R
evised: 01 November 2021
SECTION IV- Enrollment Certification
****Filled by Certification Official at Postsecondary Institution****
“This document contains information exempt from mandatory disclosure under the FOIA. Exemption 5 U.S.C. 553(b) (6)
applies. This document also contains personal information which is protected by the Privacy Act of 1974 and must be
safeguarded from unauthorized disclosure”
_________________________________________________________________________________________________________________
Request the postsecondary institution provide the following information in order to certify member’s enrollment
to complete the application packet for TN STRONG Act tuition reimbursement as outlined in the State of
Tennessee Public Chapter No.216 And
Rule 0930-02-01.
Name of Student (Last, First, Middle Initial):
SSN: (Last 4)
Degree Major:
ENROLLMENT DATA
Class Start/End Dates
(YYYYMMDD)
Course Number
Course Title
Total
Hours
Credit/Clock
Cost per Hour
Total Charges
START
END
Total Credit Hours Earned Towards Degree:
Number of Hours Enrolled:
Total Tuition Charges:
CERTIFICATIONS – The provisions described on this sheet are certified to be correct as of date signed below.
Name and Address of Financial Aid/Bursar’s Office:
Phone Number:
Email:
Printed Name and Signature of Certifying Official:
Date Signed:
(YYYYMMDD)
SECTION V- STA MANAGER REVIEW
I certify that the Member’s application packet contains all required documents and I have properly reviewed this
application packet.
☐
Accepted
☐
Rejected
STA M
anager Signature: Date:
Tuition Amount
Accepted:
Page 3 of 5
Revised: 01 November
2021
Tennessee National Guard
STRONG Act Tuition Reimbursement
Statement of Understanding
Applicants must initial each paragraph indicating the acceptance of this Agreement.
This is a legal acknowledgement for record & is considered supporting documentation.
I understand to be eligible for STRONG Act tuition reimbursement, I must be a member of the Tennessee National
Guard and have not missed a ship date * to begin basic military training prior to current course start date.
_____ (Initials)
I understand I must serve in the Tennessee National Guard for for at least a portion of the applicable academic
term for which I am applying for STRONG Act benefits, and that my term of service may not expire during
the academic term for which I am applying for benefits. _____ (Initials)
I understand it is my sole responsibility to submit all required documentation listed in the next statement as
part of a complete application packet within 45 days of course completion. Failure to do so will result in
being disqualified for reimbursement consideration regarding this request. _____ (Initials)
I understand a complete TN STRONG Act application consists of the initial 5 page reimbursement request,
unofficial transcript for the term reimbursement is requested, and the latest student account summary or
itemized bill for the term reimbursement is requested. _____ (Initials)
I understand that if I am eligible for Federal Tuition Assistance (FTA), I must use FTA in conjunction with
STRONG Act tuition reimbursement. Failure to do so will result in a reduced reimbursement
amount. I understand it is my sole responsibility to determine my FTA eligibility by contacting the TNNG
Education and Incentives Office or by contacting ArmyIgnitED. If I am NOT eligible for FTA at the time of
this request submission, I must notify the STRONG Act Manager providing proof/verification. _____ (Initials)
I understand if I am a non-scholarship Army ROTC Cadet, I may be eligible for, and therefore required to,
use FTA in conjunction with TN STRONG. It is my responsibility to determine my FTA eligibility by
contacting the TNNG Education and Incentives Office or ArmyIgnitED. _____ (Initials)
I understand if I am attending a private institution, any reimbursement I receive will be capped at the state’s
average cost of in-state tuition established by the TN Higher Education Commission. ____ (Initials)
I understand that actual tuition reimbursement may be adjusted based on any FTA, federal, state, and/or other
military education benefits received during the term STRONG Act is requested. _____ (Initials)
(*ship date for purposes of this program refers to the date a TNG Member departs to begin basic military
training.)
Page 4 of 5
R
evised: 01 November 2021
Tennessee National Guard
STRONG Act Tuition Reimbursement Statement of
Understanding
I understand I cannot exceed 120 undergraduate credit hours or 40 graduate credit hours of
reimbursement inclusive of any transfer or awarded semester hours I have been given credit for prior to TN
STRONG Act usage. _____ (Initials)
I understand I must achieve a GPA of 2.0 for undergraduate level courses or a GPA of 3.0 for graduate
level courses for the academic period which STRONG Act tuition reimbursement is being requested.
_____ (Initials)
I understand if I am applying for TN STRONG Act tuition reimbursement for a graduate program, I must
have graduated from military advanced leadership training and I will provide documentation (e.g. Army
DA1059 or Air VMPF RIP education portion) of said training with my initial application request.
_____ (Initials)
Advanced leadership training is defined as:
ARMY
AIR
Advanced Leaders Course (ALC)
Airmen Leadership School (ALS)
Warrant Officer Advanced Course (WOAC)
Squadron Officer School (SOS)
Captains Career Course (CCC)
I understand if STRONG Act tuition reimbursement is approved, it shall not exceed the actual
tuition charged by my chosen institution approved to receive state or federal funds. _____ (Initials)
I understand that TN STRONG Act tuition reimbursement must be paid to an educational institution, not to
the individual. _____ (Initials)
I understand I must notify the State Tuition Assistance Managers if this funding results in a degree (Associates,
Bachelor’s or Master’s). _____ (Initials)
I understand that my questions regarding the program, application process, or payment information should
be directed to the State Tuition Assistance Manager. _____ (Initials)
I have read and understand that if I do not comply with all of the above, I will not be approved
for STRONG Act tuition reimbursement. _____ (Initials)
I understand that the STRONG Act tuition reimbursement program is subject to the availability of
funds and appropriations as set by the Tennessee State Legislature and any limitations set forth in
Public Chapter No. 216. _____ (Initials)
Applicant’s Signature Date
(See Guidelines and Instructions for ‘ArmyIgnited’ accounts
on tn.gov/military/programs-benefits/education-incentives.)
Page 5 of 5
R
evised: 01 November 2021
Tennessee National Guard
STRONG Act Tuition Reimbursement
Authorization to Release
Student Name: _________________________ SSN: XXX-XX-________
This form allows students to authorize the release of confidential academic, financial aid, disciplinary and
student account information otherwise protected by the Family Educational Rights and Privacy Act (FERPA) to
designated person(s). These designated person(s) will have access to the student’s grades and progress reports,
certain disciplinary records, and other information related to academic progress, financial aid, and student
financial accounts.
In an attempt to handle requests for grades, account balances and/or financial aid information, etc. we
request that the student complete this form at the time of registration. This release allows the chosen
postsecondary institution listed below to discuss this information with the Tennessee National Guard
without delay.
If for any reason, I decide to change any information on this form, I must notify my chosen
postsecondary institution immediately.
Authorization: Initial the following boxes and complete requested information below:
_____ Under the Family Educational Rights and Privacy Act (FERPA), the postsecondary institution listed
below is permitted to disclose information from your education records to the Tennessee National Guard with
your consent. By signing this form you agree to allow your institution to release information from your
academic records. I consent to the disclosure of any personally identifiable information (PII) from my
education records to the Tennessee National Guard, as my institution finds appropriate.
_____ I hereby authorize the release of my grades, upon availability, to the Tennessee National Guard
_____ I hereby authorize the release of information related to my student account and any financial aid
received, including oral and/or written communication with the postsecondary institution listed below, as
requested.
Postsecondary Institution Name: _______________________________________
Postsecondary Institution POC: _________________________________________
Student’s Address__________________________________________________________
Student’s Signature: _____________________________________ Date: ______________
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Application Instructions for TN STRONG Act (University of Tennessee, Knoxville)

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Completed 14 April 2022

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