Application For Tuition Credit Form - Nebraska
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1FOR OFFICE USE ONLY
FOR: CY 20 _____
REVIEWED: _________
APPLICATION FOR TUITION CREDIT
I hereby apply for tuition credit under Section 80‐901 R.R.S. Nebraska. I am a Nebraska resident and an enlisted
member of the Active Selected Reserve and belong to the following Nebraska Reserve Unit:
CONTACT
_______________________________________________
_____________________________
UNIT:
TELEPHONE:
CONTACT
_______________________________________
_________________________________
UNIT CONTACT:
EMAIL:
MAILING ADDRESS OF UNIT:
I have a minimum of two years remaining on my enlistment, with discharge (ETS) being __________________ ,
at the beginning of my term of study, which starts _______________ at the following institution:
_______________________________________________________________
PREVIOUS APPLICANT
ACADEMIC TRANSFER
I understand this application is only effective so long as I maintain satisfactory service in my unit and pursue a
course of study that satisfies the normal requirements of the school.
My original term of enlistment was for ________ years. I will complete 10 years of service on _____________ .
I have read the attached regulations regarding the tuition credit and agree that I meet all the requirements as
set forth in the state statute.
_____________________
STUDENT I.D.#:
HOME ADDRESS:
_ _______________________
BIRTH DATE:
________________________________
E‐MAIL:
PHONE #: _________________________________
PRINTED
_ ______________________________________________
NAME & RANK:
_________________
_________________________________________________
DATE SIGNED:
SIGNATURE:
CERTIFICATION
I, the undersigned, state that I am the Commander of the above individual, that I am the custodian of the
Reserve records of the above‐named individual, that I have reviewed the same and this application, that said
individual is maintaining satisfactory participation with this unit and that I recommend said application be
approved.
PRINTED
_ ______________________________________________
NAME & RANK:
_________________
_________________________________________________
DATE SIGNED:
SIGNATURE:
ENDORSEMENT
Application #: ________________ is approved this _______ day of ________________________ , 20 _________
__________________________________________
Director ‐ Department of Veterans’ Affairs
NDVA RTC (3/2009)
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