Fill - Free fillable Tvc-ed-1-hazlewood-application - Form TVC-ED-1-Texas_Hazlewood_Act_Exemption

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TexasHazlewoodActExemptionApplication

SupportingDocumentationInstructions

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TVC‐ED‐1a

Eff.June2016

Page1of1 

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TEXASVETERANSCOMMISSION

Phone:1‐877‐898‐3833or512/463‐3168|TTY/TDD:Dial711|Fax:512/475‐3932|E‐Mail:Education@tvc.texas.gov|Web:www.tvc.texas.gov

AnEqualOpportunityEmployer

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ToapplyfortheTexasHazlewoodActExemption,youmustsubmitthefollowingdocuments

toyourcollegeoruniversity:

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1. TheHazlewoodExemptionApplication (completedandsigned).Foratutorialoncompletingtheapplication,visit:

http://www.tvc.texas.gov/Hazlewood‐Act.aspx.

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2. ReportofSeparationorDischarge,DDForm214 (andDDForm215iftheDDForm214hasbeenamended)–To

verifytheVeteran’splaceofentry,homeofrecordatthetimeofentry,characterofservice,lengthofservice,and

datesofservice.Thecopyyouprovidetoyourinstitut

ionmustbelegibleandcontaintheinformationlistedabove.

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ADDForm214maybeobtainedfromtheNationalArchives:

http://www.archives.gov/veterans/military‐service‐records/.

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IftheVeteranwasdischarged prior toJanuary1,1950previously usedseparationdocumentsmaybeused.Ifthe

Veteran’s DD Form 214 was destroyed in the National Archives fire in 1973 or is otherwise unavailable, then the

followingdocumentsmaybeused:

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 NAForm13038,CertificationofMilitaryService

 DocumentationfromtheNationalArchivesthattheVeteran’sNAForm13038wassentinlieuoftheDDForm

214duetotheDDForm214notbeingonfile

 Documentation that Veteran met the requirements of Subchapter B, Chapter 54, Texas Education Code for

residenttu

itiononthedateofentryintoactivedutyindicatedontheDDForm214

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3. Certificate of Eligibility for federal GI Bill benefits – To verify eligibility for the Veteran’s, or dependent’s federal

educationbenefits.Certificatesofeligibilitymaybeobtainedbycompletinganapplication ontheVeteransOnline

Application(VONAPP)websiteathttps://www.ebenefits.va.gov/ebenefits/vonapp.

 IftheVeteran’sfinaldischargeispriorto9/11/2001thecertificateofeligibilityisnotrequired.

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4. IftheVeter andiedwhileinservice:ReportofCasualty,FormDDForm1300–ToverifytheVeteran’splaceofentry

orhomeofrecord,andthathis/herdeathwasservicerelated.

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5. If the Veteran is deceased (not service connected) – Death Certificate for deceased Veteran for use in a Legacy

transfer.

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6. IftheVeteranistotallydisabledorindividuallyunemployableduetomilitaryservice‐relatedillnessorinjury:You

musthaveacurrent(withinoneyear)disabilityratingsdecisionletterfromtheVAindicatingthatrating.

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7. IfyouarenottheVeteran,RelationshipDocu mentation–Su bmitoneormoreofthefollowingdocuments toverify

yourrelationshiptotheeligibleVeteran.

 BirthCertificate,orMarriageCertificate,orAdoptionPapers,orRecentIRSTaxTranscript:

https://www.irs.gov/individuals/get‐transcript.

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8. VeteransmustresideinthestateofTexasduringthetermthattheexemptionwill beused.

 ChildrenandspouseofeligibleVeteransmustbeclassifiedasaTexasresidentbytheirinstitution. 

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9. HazlewoodOnlineDatabaseRegistration–TocomplywiththeFederalEducationalRightsandPrivacyAct(FERPA)

requirements,allapplicants(Veterananddependents)mustregisterintotheHazlewoodonlinedatabasetousethe

HazlewoodExemptionathttps://hazlewood.tvc.texas.gov/students/.

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TexasHazlewoodActExemption

Application



TVC‐ED‐1

Eff.June2016

Page1of2 



TEXASVETERANSCOMMISSION

AnEqualOpportunityEmployer

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For(Term)     (Year) at(Institution)     

*Submitthisapplicationtoyourcollegeoruniversity,nottotheTexasVeteransCommission*

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EachVeteran,child,orspouseapplyingtoreceiveanexemptionthroughtheHazlewoodAct,(TexasEducation

Code §54.341) must complete and sign this application  and provide the institution with the documentation

required to verify eligibility as indicated in this packet. Submit this application and all supporting

documentationtoyourinstitution’sHazlewoodActExemptionadministrator.

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Iamapplyingas(checkonlyone): 

[

]aVeteranintendingtousetheHazlewoodExemption(CompletePartsA,C,&D)

[

]achildintendingtoreceiveaLegacytransferofbenefits(CompletePartsA‐E)

[ ]achildofatotallydisabled,service‐relateddeceased,KIA,orMIAVeteran(CompletePartsA‐D)

[ ]aspouseofatotallydisabled,service‐relateddeceased,KIA,orMIAVeteran(CompletePartsA‐D)

Iam(checkonlyone):

[ ]anapplicantapplyingforthefirsttime;or

[ ]apreviousHazlewoodrecipientwhohasusedhoursatinstitution(s).

Totalpriorhoursused:Veteran,Legacy

(transferredhrs.)

,Spouse,Child

(w/ownhrs.)  



Veteran’sName:     

 LastName FirstName MI

Veteran’sSSN: DateofBirth://

(MM/DD/YYYY)

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Veteran’sStudentID#(ifapplicable): 

Address:       

 Street City State ZipCode

PhoneNumber:  Emailaddress: 



RelationshiptoVeteran:

[

]BiologicalChild[ ]Step‐child[ ]AdoptedChild[ ]IRSDependent[ ]Spouse



Child’s/Spouse’sName:     

 LastName FirstName MI

Child’s/Spouse’sSSN:  DateofBirth: //

(MM/DD/YYYY)



Child’s/Spouse’sStudentID#:(ifapplicable)  

PermanentAddress:       

 Street City State ZipCode

PhoneNumber:  Emailaddress: 

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To qualifyfor the Hazlewood Exemption,the Veteran, child orspouse cannot be indefault on aloan that is

madeorguaranteedbythestateofTexas.Stateloanscanbeviewedathttp://www.hhloans.com/.

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DoestheVeteran,childorspousehavealoanthroughtheTexasHigherEducationCoordinatingBoard?

 [

]Yes [ ]No

Ifyes,istheloanindefaultstatus?

 [ ]Yes [ ]No [ ]NotApplicable



PartA

–

Veteran’sInformation

PartB

–

OtherUserInformation

PartC

–

LoanVerification



TexasHazlewoodActExemption

Application



TVC‐ED‐1

Eff.June2016

Page2of2 



TEXASVETERANSCOMMISSION

AnEqualOpportunityEmployer



TheTexasHazlewoodActExemptionentitleseligiblepersonstoan exemptionoftuitionandspecifiedfeesof

upto150semestercredithoursatpublicinstitutionsofhighereducationinTexas.Exceptforrecipientswho

arethespouseorchildrenofeligibleVeteranskilledinaction,missinginaction,orwhosedeathresultedfrom

a service‐related injury or illness; all other Hazlewood recipients meet the grade point average satisfactory

academicprogressrequirementsandotherrequirementsofTexasEducationCode§54.2001.



IgrantpermissiontoanyinstitutionIhaveenrolledinorintendtoenrollintoreleasecredithourinformation

pertainingtomyenrollmenttotheTexasVeteransCommissionandtheTexasHigherEducationCoordinating

Board, and further grant permission to the  Commission and Board to share such information with any

institutionthatImightattend.IcertifythattheinformationIhaveprovidedistrueandcorrecttothebestof

myknowledge.IfurtherunderstandthatifIhaveprovidedinaccurate,incomplete,oruntrueinformationon

thisapplication,Imayberequiredtoreimbursethe institutionfortuition,fees,andpenaltiespertainingtothe

HazlewoodExemption.



Veteran’sSignature:  Date: 

(Veteran’ssignatureisnotrequirediftheeligibleVeteranistotallydisabled,service‐relateddeceased,MIA,orKIA.)



Child’s/Spouse’sSignature:  Date: 

(Ifapplicable.)



*Submitthisapplicationtoyourcollegeoruniversity,nottotheTexasVeteransCommission*



The Texas Hazlewood Exemption allows eligible Veterans or a designee to transfer all unused hours of the

exemption,upto150semestercredithours,toachildwhois25yearsoldoryoungeronthefirstdayofthe

term.Legacyrecipientswillreceiveanexemptionforthenumberofdegreecertifiedhoursassoc iatedwiththe

specificdegreeorcertificateprogramheorshe isenrolledinconsistentwiththeprogramlengthasdefinedin

the school catalog as approved by the regional accreditation commission. Legacy recipients must meet the 

gradepointaveragesatisfactoryacademicprogressrequirementsandotherrequirementsofTexasEducation

Code§54.2001.AssignedhoursmayberevokedbytheVeteranorthedesignee.

I(Veteran)

    waivetherighttoalloftheunusedportionofmyHazlewood

Exemption and grant permission to transfer those unused Hazlewood hours under Texas Education Code

§54.341(k)(LegacyAct)tomyeligiblechild,(child)     .Iagreetorelease

current term and historic credit hour information to the Texas Veterans Commission and the Texas Higher

Education Coordinating Board to determine the balance of my unused hours. I grant permission for the

CommissionandBoardtosharesuchdatawithanyinstitutionthatmyeligiblechildmightattend.Iunderstand

thatonly oneeligible personmayuse myhoursfora particularterm.I herebycertify the informationI have

provided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.



Veteran’sSignature:  Date: 



*IfthequalifyingVeteranisdeceased,theVeteran’sDesignee(PrintName)

    



maysignaboveinVeteran’splace*

Veteran’sChild’sSignature:  Date: 

*Submitthisapplicationtoyourcollegeoruniversity,nottotheTexasVeteransCommission*

PartD

–

Veteran,Child,andSpouseCertificationandConsent

PartE

–

LegacyChildCertificationandConsent

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Tvc-ed-1-hazlewood-application - Form TVC-ED-1-Texas_Hazlewood_Act_Exemption_Application, June 2016

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