Fillable PARENT LETTER The proponent department is the College (Northwest Vista College)

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PARENT LETTER The proponent department is the College (Northwest Vista College)

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VA FORM 1, DEC 2019
Page 1 of 2
Alamo Colleges District, Student Success V3.02
VA ENROLLMENT CERTIFICATION REQUEST
The proponent department is the College Veterans Affairs Office
THIS FORM IS PROTECTED UNDER THE FAMILY EDUCATIONAL RIGHTS AND PRIVACY ACT OF 1974
AUTHORITY:
San Antonio College Catalog
PRINCIPAL PURPOSE: Request by a student to receive certification enrollment for veteran benefits.
ROUTINE USES:
Used to evaluate and determine certification for Federal and State veteran benefits.
DISCLOSURE: Voluntary. Failure to furnish information may result in denial of certification.
1. STUDENT ID
2. HOME COLLEGE
☐ PARENT LETTER
□ NLC ☐ NVC ☐ PAC ☐ SPC ☐ SAC
3. DATE OF REQUEST
4. STUDENT NAME (LAST, FIRST, MI)
5. ACES EMAIL
@student.alamo.edu
6. DATE OF BIRTH
7. PRIMARY STREET ADDRESS
8. CITY
9. STATE
10. ZIP
11. PRIMARY PHONE
12. EMERGENCY CONTACT PHONE
13. CHANGE OF ADDRESS?
□ YES ☐ NO
14. SOCIAL SECURITY NUMBER
15. DEGREE
☐
AA
☐
AS
☐
AAS
☐
AAT
☐
CERTIFICATE
16. DEGREE/AREA OF STUDY
** IMPORTANT NOTE** Students must enroll for the certification process to begin. Courses listed for payment must be part of your current degree
program. Students must notify the College Veterans Affairs (VA) office of any changes to enrollment status (Add/Drop/Withdraw), failure to do so may
result in over-payments and/or debts to the college or Federal VA, which the student assumes FULL responsibility. Internet Developmental Courses
and
3-Peat fees do not qualify for certification for payment of VA education benefits. Certification may take up to 6 weeks to process. ***
17. MILITARY STATUS (PLEASE SELECT ONE)
□ VETERAN ☐ FAMILY MEMBER-SPOUSE ☐ FAMILY MEMBER-CHILD ☐ Active Duty
18. LIST EVERY UNIVERSITY/COLLEGE YOU HAVE ATTENDED AS A STUDENT (MUST SUBMIT ALL OFFICIAL TRANSCRIPTS)
(ONLY COMPLETE WHEN THIS IS YOUR FIRST TIME BEING CERTIFIED AT THIS COLLEGE)
19. YEAR REQUESTED
☐
☐
☐
21. LIST THE COURSE(S) REQUESTED TO BE CERTIFIED FOR VA BENEFITS AND HAZLEWOOD EXEMPTIONS
CREDIT HOURS
COURSE NAME(S) & COURSE NUMBER(S)
i.e. HIST-1301, ENGL-2332...
SEMESTER TYPE
i.e. 16 Week, Flex 1…
COLLEGE
i.e. NLC, NVC …
LOCATION OF CLASS
(OFFICIAL USE ONLY)
Total Hours
VA FORM 1, DEC 2019
Page 2 of 2
Alamo Colleges District, Student Success V3.02
VA ENROLLMENT CERTIFICATION REQUEST
The proponent department is the College Veterans Affairs Office
22. STUDENT ID
23. STUDENT NAME (LAST, FIRST, MI)
24. REQUESTED BENEFIT(S) (PLEASE SELECT ALL THAT APPLY)
□ CH 30 MONTGOMERY GI BILL
□ CH 31 Rehab (S901112229)(F901376553) PO#
□ CH 33 POST 9/11 (S901112219)(F901376552) %
□ CH 35 DEPENDENT: CLAIM #
□ CH 1606 RESERVE/NATIONAL GUARD
CREDIT HOURS FOR VA BENEFIT
Comments:
□ HAZLEWOOD LEGACY, 800027%
□ HAZLEWOOD ORPH DEP, 800037%
□ HAZLEWOOD SPOUSE, 800047%
□ HAZLEWOOD (VET/DEP), 800057%
% CREDIT HOURS FOR HAZLEWOOD
25. REQUEST FOR TUITION AND FEE DEFERMENT (9IPV Veteran):
☐
NO
Texas Education Code §56.0065 ☐ YES, I have read and agree to the terms of form TVC-ED-6.
FOR OFFICIAL VA OFFICE USE ONLY
VA Approval Comments:
CHAPTER 33 TERMS:
1.
The student enrolls at the Alamo Colleges District.
2.
The student applies for the Certification of Eligibility through the college Veterans Affairs Office.
3.
Alamo Colleges District is responsible to refund the Federal VA in the case where a student fails to attend on class day.
If the student attends at least one day of class and a refund is processed it is the student’s responsibility to refund the Federal VA.
CONDITIONS:
1.
In the event that the student is not eligible for the maximum eligibility, the College must receive a payment within 30 days, as
described in the terms above. It is the student’s responsibility to make payment within the appropriate dates without regards for
the College billing procedures or postal delays.
2.
In termination of enrollment for any reason, the unpaid balance of tuition and fees is due and payable immediately.
3.
The return of a non-sufficient check does not constitute a drop. If a check is returned by the maker’s bank unpaid, the
maker is responsible for the unpaid balance, plus the return check charge, which is due immediately.
4.
Any unpaid balance is sent to a collection agency. The fee charged by the collection agency is added to the student’s account.
The college’s failure to enforce all terms and conditions stated herein shall not constitute a waiver of the underlying obligations
agreed to by the student.
5.
A student who fails to make full payment of tuition and fees, including any incidental fees, by the due date may be prohibited
from registering for class until full payment is made.
IT IS HEREBY AGREED THAT:
I acknowledge and accept responsibility for all debts plus any collection fees owed to the Alamo Colleges District under the terms and
conditions stated herein, and agree that:
1.
I will notify Admissions and Records of any change in my mailing address;
2.
I will not be allowed to register for any succeeding academic period unless all debts to the College have been paid; and
3.
I will not be allowed to receive an official transcript of any work completed at the Alamo Colleges District unless all debts to the
College have been paid.
WITH MY SIGNATURE BELOW, I ACKNOWLEDGE THAT I HAVE READ AND AGREE TO THE TERMS AND CONDITIONS
26. STUDENT SIGNATURE
27. DATE
FOR OFFICIAL VA OFFICE USE ONLY
28. RECEIVED BY
29. DATE
Tuition Deferment Request for Eligible
Texas Veterans and Their Families
Pursuant to Tex. Ed. Code §56.0065 (H.B. 846, 85th(R), effective Sept. 1, 2017)
TVC-ED-6
Eff. Sept. 2017
Page 1 of 2
TEXAS VETERANS COMMISSION
Phone: 1-877-898-3833 or 512/463-3168 | TTY/TDD: Dial 711 | Fax: 512/463-3932 | E-Mail: Education@tvc.texas.gov | Web: www.tvc.texas.gov
An Equal Opportunity Employer
*Submit to the institution of higher education you are attending, not the Texas Veterans Commission*
Name Student ID#
For (Term) (Year) at (Institution)
P
urpose: The purpose of this form is to “prescribe a standard deferment request form… [for] a student eligible for
state or federal military related student financial assistance programs for military veterans or their family
members… to defer payment of tuition and fees if the receipt of military related financial assistance awarded to
the student is delayed by less than 60 days” (H.B. 846, 85th(R)). This form will be used by all institutions of higher
education and private institution of higher education (IHE) in Texas.
Category of State or Federal Veterans’ Education Benefit or Assistance Using (Check All That Apply)
[ ] Montgomery GI Bill (Ch 30)
[ ] Montgomery GI Bill-Selected Reserve (Ch 1606)
[ ] Vocational Rehabilitation (Ch 31)
[ ] Reserve Educational Assistance Program (Ch 1607)
[ ] Post-9/11 GI Bill (Ch 33)
[ ] Fry Scholarship
[ ] Dependents’ Educational Assistance (DEA) (Ch 35)
[ ] Tuition Assistance
[ ] Hazlewood Act
[ ] Child of POW/MIA
[ ] Non-Resident Waiver
[ ] Other:
Background: Provide an explanation that describes why you need a tuition and fee deferment. Include any
information on any attempts you have made to rectify the situation. This will allow IHE representatives to better
assist you with your application to use Department of Veterans Affairs (VA) or State of Texas military related
financial assistance. Attach additional sheets if necessary.
*Submit to the institution of higher education you are attending, not the Texas Veterans Commission*
Tuition Deferment Request for Eligible
Texas Veterans and Their Families
Pursuant to Tex. Ed. Code §56.0065 (H.B. 846, 85th(R), effective Sept. 1, 2017)
TVC-ED-6
Eff. Sept. 2017
Page 2 of 2
TEXAS VETERANS COMMISSION
Phone: 1-877-898-3833 or 512/463-3168 | TTY/TDD: Dial 711 | Fax: 512/463-3932 | E-Mail: Education@tvc.texas.gov | Web: www.tvc.texas.gov
An Equal Opportunity Employer
*Submit to the institution of higher education you are attending, not the Texas Veterans Commission*
In requesting a deferment of payment of tuition and fees, my initials preceding the statements below
certify my understanding of each item.
X____
____
I have verified my remaining entitlement of one or more of the veterans’ benefits or assistance
programs checked on Page 1. I believe my eligibility and anticipated funding to be sufficient to
cover the tuition and fees for this term;
X________
I understand that this deferment does not pay my tuition and fees, but it allows me an extension of
time up to 60 days from the first day of the semester or term to pay tuition and fees in full;
X____
____
I have formally requested an enrollment certification through my IHE VA Certifying Office and/or
other applicable office for processing tuition exemptions and waivers and expect to receive the
applicable benefit for the current term;
X____
____
I understand that if I do not receive the education benefit checked above that I am still required to
pay all tuition and fees to the IHE I am attending and withdrawal after the first day of classes does
not eliminate this obligation;
X________
I understand that the tuition and fees being deferred are subject to my IHE’s late and refund
policies if not received by the 60th day from the first day of the semester or term;
X________
I understand that all academic records and enrollment registration may be held if all financial
obligations to the college are not settled in a timely manner;
X________
I understand that my tuition and fees must be paid in full no later than 60 days from the first day of
class of the semester or term before I will be allowed to register for classes for subsequent terms;
X____
____
I understand that my eligibility for tuition and fee deferments under Tex. Ed. Code §56.0065 may
terminate if I do not follow applicable rules and regulations or otherwise fail to act in good faith
and to the best of my ability with timely and reasonable payment(s) of tuition and fees.
I
certify that all of the above information on all pages is true and correct to the best of my knowledge and belief.
Signature _________________________________ Date
Received by: __________________________________________________ ___ Date _______________________
*Submit to the institution of higher education you are attending, not the Texas Veterans Commission*
Revised 9/2020
Academics
______Due to FERPA laws, academic and VA benefit advising will not be conducted at the SAC VA in-take
desk or lobby area. If needed, I must request to meet with my Certified Academic Advisor or the Vet Success
On Campus Counselor (VSOC).
______I am required to disclose all prior college course credits to SAC VA and submit all transcripts from all
colleges, universities and military to SAC Admissions and Records prior to my first term at SAC.
______I will register for courses independently and ensure they are required on my signed and authorized
academic advising guide in the SAC VA office.
______If my department needs to change any courses on my advising guide, I need to obtain a course
substitution letter signed by my academic department and submit it to the SAC-VA office.
______I AM RESPONSIBLE FOR TRACKING MY COURSE ENROLLMENT. Therefore, I will visit the
SAC-VA office every term after registering, dropping, adding or when any changes are made to my courses as
this may directly affect my benefit reimbursement.
______I should complete a current FAFSA for each academic year, despite my known or unknown status for
financial aid. To complete the FAFSA, use the webpage: www.fafsa.edu.gov
Certification
______I must obtain and provide the necessary documents to the SAC-VA office for each term that I wish to
certify courses. My certification may be delayed if all necessary documents are not on file. If needed,
additional documentation may be requested at a later date by the SAC-VA Office or Dept. of Veterans Affairs.
______Documents submitted to the SAC-VA office will be processed on a first come first serve basis and
depends on final approval by the VA regional office.
______My requested credit hours for certification may be changed based on various factors (i.e. courses taken
on-line, retaking courses that satisfy graduation requirements, three-peats, remedial courses without test
placement scores, remedial courses taken on-line, change of major, grade point average etc.).
______I assume full responsibility to reimburse funds to SAC or the VA if an overpayment occurs as a result of
any changes from my original certification.
______I am responsible for making a payment or setting up a payment plan to the SAC Bursar office if my VA
education benefit does not pay for tuition or it is a payment deadline.
______For questions regarding the status of my benefits after my SAC-VA certification, I will contact the Dept.
of Veterans Affairs Regional Office in Muskogee by calling 1 (888) 442-4551.
______While attending San Antonio College this form will serve as a reminder that I will be responsible for the
above requirements and responsibilities as long as I am enrolled and attending at any given semester.
_______________________________________________________________________________________
STUDENT SIGNATURE DATE BANNER I.D.
*By initialing and signing, I am responsible for the above student responsibility statements.
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PARENT LETTER The proponent department is the College (Northwest Vista College)

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Completed 1 November 2020

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