Fillable Application for Participation in the Academic Common Market

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Application for Participation in the Academic Common Market

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State Council of Higher Education for Virginia Page 1 of 4 Revised 11.2019
Application for Participation in the Academic Common Market
- IMPORTANT INFORMATION FOR APPLICANTS -
About the Academic Common Market (ACM)
The Academic Common Market (ACM), administered by the Southern Regional Education Board (SREB), is a tuition-
savings program for college students in 15 SREB states, who want to pursue degrees that are not offered by their four-
year, public in-state institutions. Students can enroll in participating out-of-state, four-year public institutions that offer
their degree program and pay the institution’s in-state tuition rates. The following states are partners - Alabama,
Arkansas, Delaware, Florida, Georgia, Kentucky, Louisiana, Maryland, Mississippi, Oklahoma, South Carolina,
Tennessee, Texas, Virginia, and West Virginia. Visit www.schev.edu/acm for additional information.
Student Eligibility Requirements
Students may apply for ACM eligibility if they:
Are a domiciled Virginia resident. Visit www.schev.edu/residency for more information.
Have been officially accepted or enrolled into the specific program of study offered at the out-of-state
institution and this program is listed in the current Virginia ACM inventory and available to Virginia residents.
Note: Students who have been "provisionally" admitted into an ACM major or who must complete coursework
before they are fully admitted to the program are NOT eligible for ACM tuition benefits until they are formally
accepted into the major.
Application and Review Process
Applications are accepted at any time. Students are strongly advised to submit their ACM application as soon as
possible but no later than six weeks prior to their institution’s deadline or the start of classes, whichever is
earlier.
Students must complete and mail the application and required supporting documents to the State Council of
Higher Education for Virginia (SCHEV) at the mailing address at the bottom of page 4 of the application
(please do not include staples or paperclips). Emailed or faxed application materials are not accepted.
Once the application packet is received, the initial review process can take four (4) to six (6) weeks
depending on the number of applications awaiting review.
Applications are reviewed in the order they are received and incomplete or illegible applications will be delayed.
If additional information is needed, an email will be sent to the email addresses provided on the application.
If approved, SCHEV will issue a certification letter for ACM participation to both the student and institution, then
the institution will either grant the student an out-of-state tuition waiver or apply the in-state rate.
Important Notes:
o SCHEV is unable to accommodate requests to expedite applications.
o SCHEV does not confirm receipt of applications unless contacted.
o Waivers and in-state rates are not retroactive, except at the discretion of the institution.
o Certification is a one-time procedure provided that the institutional requirements and the student’s major
and residency remain unchanged.
Application Deadlines
SCHEV does not impose ACM deadlines nor do we recognize deadlines set by institutions. Students should contact their
institution’s ACM Coordinator to inquire about set deadlines for designation of the in-state rate/ACM participant. Contact
information can be found at www.sreb.org/academic-common-market.
Disclaimer: As the coordinating agency for the Commonwealth of Virginia’s ACM participation, the State Council of Higher Education for
Virginia (SCHEV) reserves the right – at its discretion and at any time – to remove academic programs offered by Virginia institutions
from the ACM and/or remove access to academic programs at out-of-state institutions offered to Virginians through the ACM. When an
application is made to an out-of-state institution, Virginia domiciliary residents interested in applying for the ACM should review the
online program inventory in order to determine the program’s status (active or inactive). Students beginning studies at one institution or
in one program with the intent to transfer to a participating institution or program are not guaranteed ACM access if the institution or
program becomes ineligible during their time at the institution or in the program of origin.
Participating 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.
Public Law 93-579, referred to as the Federal Privacy Act, requires that any federal, state, or local agency that requests an individual
to disclose his Social Security number inform the individual by which statutory or other authority the number is solicited, whether
that disclosure is mandatory or voluntary, and what uses could be made of it. SCHEV, as required by published regulations, requests
each applicant for its student aid programs to submit a Social Security number on a voluntary basis. SCHEV uses a student’s Social
Security number for unique identification purposes in the application and reporting processes.
State Council of Higher Education for Virginia Page 2 of 4 Revised 11.2019
Application for Participation in the Academic Common Market
– PLEASE READ CAREFULLY AND TYPE (PREFERRED) OR PRINT IN INK –
Instructions and Required Supporting Documentation
To apply, students must submit the documents below. It may be helpful to check each box as the step is completed. Please
do not include staples or paperclips. Emailed or faxed application materials are not accepted.
Completed ACM application
Be sure to read all directions carefully. Processing of your application will be delayed unless all questions are
completed, all documentation is enclosed, and the application is signed and dated by the appropriate person(s).
Copy of college acceptance or enrollment letter stating the exact ACM-eligible major/program and start term
The letter must be on letterhead with a signature from a college official. Do not submit letters that do not include the
exact major/degree program name as listed in the ACM Program Inventory. Email or website printouts are not
accepted.
Photocopies of the three documents below supporting claim of Virginia domicile
FOR DEPENDENT STUDENTS: Submit the three documents listed below for the person (parent, legal guardian or
spouse) you list in Section D of the application.
FOR INDEPENDENT STUDENTS: Submit the three documents listed below for yourself.
Valid Virginia driver’s license or valid Virginia identification card;
Pages 1 and 2 of most recent signed federal 1040 income tax form (must include handwritten signature if
self-prepared and list of dependents if applicable); and
Pages 1 and 2 of most recent signed Virginia 760 income tax form (must include handwritten signature if
self-prepared).
FOR MILITARY STUDENTS: If you are a military dependent and the military member resides in Virginia but
maintains a domicile outside of Virginia, complete the application and include photocopies of the following:
Military member’s military orders verifying active-duty military status and permanent duty station within
Virginia or contiguous state;
Documentation of military member’s physical residence in Virginia (e.g., recent utility bill, lease, etc.); and
Student’s military dependent card issued by the military.
Se cti on A: St ude nt Bio gr aph ic al a nd Enrollme nt I nf ormat ion
Last Name
First Name
Last Four Digits of SSN
xxx-xx-
Date of Birth (mm/dd/yyyy)
Gender
Telephone Number
Email Address
MALE FEMALE
Permanent address: Street
City
State
Zip Code
Name of ACM Institution
State of ACM institution
Name of ACM Major/Degree Program
Is this an on-line program?
YES NO
Program Degree Level (e.g., B.S., M.A., Ph.D.)
Program Start Date (mm/yyyy)
Anticipated College Graduation Date (mm/yyyy)
Term Requested for ACM Certification (Check one and specify year)
FALL 20______
SPRING 20______
SUMMER 20______
Se cti on B: St u de nt Ed uca ti on Hi s to ry
Dates of Attendance
From(mm/yyyy) To(mm/yyyy)
School/College Name
State
High School
_
Undergraduate
_
Undergraduate
_
Graduate
_
State Council of Higher Education for Virginia Page 3 of 4 Revised 11.2019
Se cti on C: St u de nt De pen de n cy I nf orm at i on
1. Are you, the student, a U.S. Citizen or U.S. National?
YES
NO*
*If “NO,” attach a copy of your INS documentation, including the classification and expiration date, to this application.
2. Where have you, the student, lived in the last two years? List current address first.
From (mm/dd/yyyy)
To (mm/dd/yyyy)
Street
City
State
Zip Code
_
Today
_
_
3. Have you, the student, resided in Virginia since birth?
YES
NO
If “NO,” when did you most recently move to Virginia and why?
mm/dd/yyyy
dd
yyyy
4. Are you, the student, married?
NO
If “NO,” go to question 5; if “YES,” respond to questions 4A and 4B below.
4A.
Do you wish to claim eligibility based on your spouse’s domicile?
YES
NO
4B.
If “Yes,” does your spouse provide more than 50% of your financial support?
YES
NO
If you answered “YES” to both questions 4A and 4B, do not complete the remainder of Section C; continue on
to Section D and complete both the unboxed “Student” and boxed “Parent/Legal Guardian/Spouse” areas of the
remainder of the application with your spouse’s information.
If you answered “NO” to question either 4A or 4B, do not complete the remainder of Section C; skip to Section
E and complete only the unboxed “Student” areas of the remainder of the application.
5. Do any of the following characteristics apply to you, the student? (Check all that apply)
Age 24 or older as of first day of term in which you plan to enroll
Both parents deceased with no adoptive/legal guardian
Ward of the court or was a ward of the court until age 18
Post-baccalaureate student
Have legal dependents other than spouse
Veteran or active-duty member of the U.S. Armed Forces
Parent/legal guardian did not provide substantial financial support
AND did not claim me as a tax dependent for the past year
If you did not check any of the characteristics in question 5 above, continue on to Section D and complete
both the unboxed “Student” and boxed “Parent/Legal Guardian/Spouse” areas of the remainder of the application
with your parent/legal guardian’s information.
If you checked any of the characteristics in question 5 above, do not complete Section D; skip to Section E
and complete only the unboxed “Student” areas of the remainder of the application.
Se cti on D: P are nt/L e gal G ua rdian / Spous e In f or matio n
6. You, the student, are completing the remainder of this application for you and your (check one below):
FATHER MOTHER LEGAL GUARDIAN* SPOUSE
Parent/Legal Guardian/Spouse First and Last Name
Telephone Number
Email Address
*If “LEGAL GUARDIAN,” attach a copy of court documentation to verify legal guardianship of the student, to this application.
7. Is your parent/legal guardian/spouse a U.S. Citizen or U.S. National?
NO*
*If “NO,” attach a copy of his or her INS documentation, including the classification and expiration date, to this application.
8. Where has your parent/legal guardian/spouse lived in the last two years? List current address first.
From (mm/dd/yyyy)
To (mm/dd/yyyy)
Street
City
State
Zip Code
_
Today
_
_
9. Has your parent/legal guardian/spouse resided in Virginia since birth?
YES
NO
If “NO,” when did your parent/legal guardian/spouse most recently move to Virginia and why?
mm/dd/yyyy
dd
yyyy
State Council of Higher Education for Virginia Page 4 of 4 Revised 11.2019
Se cti on E: O ther D om icile Inf ormation
For questions 10 – 14, be sure to answer the B question if your response to
the A question is "NO.”
Student
Parent/Legal
Guardian/Spouse
10
A.
Have you been employed in Virginia in the past year?
YES
NO
YES
NO
B.
If “NO,” were you employed in:
ANOTHER STATE
ANOTHER STATE
If “NOT EMPLOYED” for “Student”, what are your source(s) of financial
support? __________________________________________________
NOT EMPLOYED
NOT EMPLOYED
11
A.
For the most recent tax year, will (or did) you file a Virginia full- or
YES
NO
YES
NO
part-year resident income tax form?
B.
If “NO,” were taxes paid to:
ANOTHER STATE
ANOTHER STATE
DID NOT FILE
DID NOT FILE
12
A.
Are you a registered voter in Virginia?
YES
NO
YES
NO
B.
If “NO,” are you registered to vote in:
ANOTHER STATE
ANOTHER STATE
NOT REGISTERED
NOT REGISTERED
13
A.
Do you hold a valid Virginia driver’s license?
YES
NO
YES
NO
B.
If “NO,” do you hold a license in:
ANOTHER STATE
ANOTHER STATE
NOT LICENSED
NOT LICENSED
14
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
15
A.
Are you an active-duty member of the U.S. Armed Forces?
YES
NO
YES
NO
B.
If “YES,” does your military Leave and Earnings Statement (LES) reflect
YES
NO
YES
NO
Virginia withholding?
If “YES,” what was the effective date of change to Virginia?
(Attach a copy of your most recent LES to this application)
mm/dd/yyyy
mm/dd/yyyy
Se cti on F: Ce rti fi c at ion & Si g na tur es
In compliance with the Family Educational Rights and Privacy Act of 1974 (FERPA) and other applicable laws, I authorize the State
Council of Higher Education for Virginia (SCHEV) and the institution I attend, or plan to attend, to disclose and receive personally
identifiable information, including my Social Security Number and any other information necessary to make an ACM eligibility
determination. I certify that all of the information I provided in this application is true and accurate. I agree to furnish SCHEV and
the institution with additional supporting documentation related to my application, if I am asked to do so. I agree to allow SCHEV to
have access to my Department of Motor Vehicle and Department of Taxation records. I understand that this application is a legally
binding document and that if I provide fraudulent information, I may be subject to repayment of tuition or dismissal, or both. I agree
to immediately notify my college or university of any name or permanent address changes.
Additionally, I have read page 1 of this application (Important Information for Applicants) and understand the following:
SCHEV’s initial review process can take 4 to 6 weeks and applications are reviewed in the order in which they are received.
SCHEV is unable to accommodate requests to expedite applications and does not confirm receipt of applications unless contacted.
SCHEV will contact me using the email addresses provided on this application if additional information or documentation is needed
and for any other issues.
If my application is incomplete or additional information is required, the normal processing timeframe may be extended.
SCHEV does not recognize deadlines set by institutions; therefore, it is my responsibility to work directly with the institution if I
have an issue.
Signature of student/applicant
Date
Signature of parent/legal guardian/spouse listed in Section D
Date
Mail completed application and supporting documentation (see page 2 and questions 1, 6, 7 and 15) to:
State Council of Higher Education for Virginia
Attention: Academic Common Market
101 North Fourteenth Street
James Monroe Building, 10th Floor
Richmond, Virginia 23219
Emailed or faxed application materials are not accepted.
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Application for Participation in the Academic Common Market

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Completed 10 January 2022

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