Application For The Benefit Of Paying In-State Tuition As A Veteran Or Spouse / Dependent Of A Veteran Or Former Service Member Or Other Covered Individuals Using Transfered Chapter 33 Page 4

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I hereby certify that all information I have set forth herein is true to the best of my knowledge, pursuant 
to my reasonable inquiry where needed. I hereby acknowledge that the institution may verify the 
information set forth herein from sources accessible under law to the institution but that the institution 
may divulge the contents of this application only as permitted under the Family Educational Rights and 
Privacy Act of 1974 if I am, or have been, in attendance at this institution.     
  
PLEASE SIGN AND DATE BELOW.    
  
Signature of Applicant________________________________   Date___________________________  
  
 
 
FOR OFFICE USE ONLY  
 
 
 
Date of Review _____________________  
Reviewed By ____________________________ 
  
Tuition Status Determined:  
In‐state 
||   Out‐of‐state  
 
  
Page 4  
  
July 31, 2015  
  

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