Statement of Student Eligibility – TEXAS Grant
Institutions are required to collect a statement (electronically or on paper) from each TEXAS Grant recipient
prior to the disbursement of funds confirming eligibility in regards to the controlled substance restrictions of
the program. This statement must be retained with the student's records at the institution and be made
available if requested in the course of a program review or audit.
Student Name: UHV ID:
Dat
e of Birth: Telephone Numb
er:
Have you ever been convicted of a felony or an offense under Chapter 481, Health and Safety Code (Texas
Controlled Substances Act), or under the law of another jurisdiction involving a controlled substance as
defined by Chapter 481, Health and Safety Code?
Yes *
No **
*
If your answer is yes, contact the financial aid office to determine your eligibility to receive a TEXAS Grant.
**
If your answer is no, it is your responsibility to inform the financial aid office if this status changes at any time while
attending the institution.
I hereby certify that the information I have provided in this statement is true and correct. I understand that
if I fail to provide accurate information, I may be required to reimburse the institution and penalties may be
imposed. I also understand that it is my responsibility to inform the financial aid office if my status
concerning this statement of eligibility changes at any time while attending this institution.
Student Signature Date
Institutions should consult with the institution's legal counsel concerning individual student situations as they
pertain to the conviction of a felony or an offense under Chapter 481, Health and Safety Code (Texas Controlled
Substances Act), or under the law of another jurisdiction involving a controlled substance as defined by Chapter
481, Health and Safety Code.
