Year

Term

Student ID #

VA Benefit Chapter

Months of Eligibility Remaining

Last Name

First Name

M.I.

Is this your first semester using VA benefits at AC?

If yes, you must supply the Veteran File Number (generally veteran's SSN)

Has any of your contact information changed since your last cerification?

Please complete your updated information below

Current/Permanent Address:

City

State

Zip Code

Phone #

Email Address

Have you changed your program of study since your last certification?

Degree Type (AA, AAS, etc.)

Major

Certification

This form Must be completed for each term the student intends to use VA education benefits. 

Students utilizing VA benefits must register for classes promptly and any forms that are submitted without registration completed are liable to be reminded due to registration inactivity.

All VA beneficiaries are responsible for understanding their benefits and how their registration can affect their registration can affect their entitlements.

Incomplete or illegible forms will not be considered and will be returned to the students for correction.

AC is not responsible for any incomplete, partial, or failed fax transmissions or emails.

By signing below, I am confirming the following:

1. I am eligible to receive VA educational benefits and request courses applicable to my degree to be certified. I have confirmed my remaining eligibility with the VA and am responsible for any charges not covered under this eligibility period.
2. I will notify the AC School Verifying Official(s) of any changes to my schedule, enrollment, address major, or status as soon as possible following the change Failure to report these changes may result in delayed benefit payments or required repayment to AC or the VA.
3. I assume full responsibility for reimbursement of funds to or the VA should an overpayment occur as a result of this certification. I understand my registration decisions can affect my monthly entitlements.
4. I understand certification requests submitted within two weeks of the start of the term will delay payment from the VA for educational benefits.

Signature (Typing your name constitutes your agreement to the terms stated on this form)

Date

Do you also need to fill out the Texas Hazelwood Act form?

IF PRINTED, RETURN FORM TO SCHOOL CERTIFYING OFFICIAL IN THE STUDENT CENTER                  

For Term

Year

at Institution

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

Student's Last Name:

Student's First Name:

Student's Middle Initial:

Student's SSN

Student's ID

Date

ADDRESS 

Street

City

State

Zip Code

Phone Number

Email Address

I am applying as (check only one)

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/.

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

If yes, Is the loan in default status?

I am applying for continuation of the exemption from payment of tuition and fees under Texas Education Code §54.341, (The Hazlewood Act). I understand that I may be entitled, under the law, to this exemption for up to 150 semester credit hours at Texas public institutions of higher education. For the purpose of accounting for the total number of hours for which I receive this exemption, I grant permission to any institution in which I have enrolled or will enroll to release credit hour information 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 I still meet the requirements in Part D or, if a Legacy Child, Parts D, and E of my initial Texas Hazlewood Act Exemption Application (Form TVC-ED-1).

How many hours have you used under the Texas Hazelwood Act Exemption?

Student's Signature

Date

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

                                                                                                                                                                                                                                                                                                                                                                                                               
* This form will not be used for initial application for the Hazlewood Exemption but may be used for enrollment of students subsequent to initial enrollment at the school in which the student is currently and consistently enrolled. If a break in enrollment or change of school occurs then the complete Hazlewood Exemption application must be completed.

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