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2009-10 APPLICATION FOR REMISSION OF FEES FOR A CHILD OF A DISABLED INDIANA VETERAN OR A POW/MIA
State Form 20234 (R18 / 5-09)

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This agency is requesting disclosure of your Social Security Number (SSN) in accordance with IC 4-1-8-1; disclosure is mandatory and this record cannot be processed without it.

Important: Applicants must also annually file a Free Application for Federal Student Aid (FAFSA), preferably by the State Student Assistance Commission of Indiana's (SSACI) published deadline. The FAFSA can be filed online at www.FAFSA.ed.gov. Applications must be completed legibly in INK, else it will be returned without verification. This application will not be returned via fax. This application has three pages: be sure to read and retain the "Filing Instruction" pages. ***VETERAN DATA*** 1. First Name _______________________________ Middle Name _______________________ Last Name ______________________________ 2. SSN * ____________________ VA File number (if different from SSN) ______________________ Service number ______________________ 3. Is the Veteran deceased? Yes No If yes, Date of death (m/d/yy) __________________ State ____________________ ZIP code ____________ 5. Branch of service ______ Dates of active duty service: From (m/d/yy): ________ 6. Telephone number (______) ______________ 7. Has/had the veteran been a resident of Indiana for 36 consecutive months? Yes No If Yes, Dates (m/yy): _____________________ To (m/d/yy): _______ Date of birth (m/d/yy) ________ 4. Current Address (or, if deceased, last known address) _____________________________________________ City _______________________

***STUDENT DATA *** 8. First Name _______________________________ Middle Name _______________________ Last Name ______________________________ 9. SSN * ___________________ Date of birth (m/d/yy) _________________ Relationship to Veteran ____________________________________ Check one: Your relationship to the veteran is: biological child legally adopted child Yes No If so, when? (If adopted, attach copies of appropriate court papers. If neither, you're not eligible for the benefit.) 10. Have you received Child of Disabled Veteran tuition and fee remissions for any prior academic year? List academic years and school(s) attended ________________________________________________________________________________ 11. Code number of State public school student will attend (see instructions for a list of eligible schools): ___________ Start Date (m/y) _________ 12. Check the degree this application will be used toward: (a) Undergraduate (b) (a) Graduate Full Time (b) Part Time 13. List whether you will attend the school listed in question 11, full or part time: Telephone number (_____) ___________________ 15. Check which one you are: Child of a Disabled Veteran Child of POW/MIA (after January 1, 1960) Child of Purple Heart Recipient (Purple Heart Documentation MUST be attached to this application.) 16. Certify by signing and dating that the above statements are true and correct and that you have read this form's Filing Instructions. Student Signature ____________________________________________________ Date of Application (m/d/yy) ______________________ By signing this application you agree that the information you have provided is true and, if asked, to provide documentation that will verify the accuracy of the information you have provided on this application and that you have read and understand the application's Program Information and Filing Instructions. WARNING: If you give false or misleading information, you may be fined, prosecuted or both.

14. Student's Address _____________________________________________ City ____________________State ______ ZIP code __________

*FOR IDVA USE ONLY*

***IDVA VERIFICATION*** *FOR IDVA USE ONLY* APPPROVED NOT APPPROVED Served in the armed forces during wartime Cannot verify service in armed forces during wartime Discharged under other than dishonorable Cannot verify a discharge under other than dishonorable Awarded of the Purple Heart Medal / wounds received Cannot verify award of the Purple Heart received Has service-connected disability of ________ % disability Cannot verify a service-connected disability of record Classified as POW/MIA, after January 1, 1960 Cannot verify classification of POW/MIA after January 1, 1960 Service connected death Verification of eligibility cannot be made ­ insufficient data Veteran and student are Indiana residents Veteran / Student Do not meet Indiana residency requirements Renewal application This certification does not verify relationship of the student to Veteran.
IDVA VERIFICATION SIGNATURE ______________________________________ Date (m/d/yy) ______________ Not Valid Without Embossed IDVA Seal. Page 1 of 3

First time applicant

PROGRAM INFORMATION ­ Read and Retain for Your Records
REMISSION OF FEES FOR A CHILD OF A DISABLED INDIANA VETERAN The Indiana General Assembly established defined educational benefits for the children of disabled Veterans. The Veterans disability must have been incurred during active military service and be rated by the U.S. Department of Veterans Affairs. The benefit covers up to 124 credit hours of tuition and regularly assessed fees (fees charged to all students) as defined by the Commission for Higher Education and the State Student Assistance Commission of Indiana (SSACI), to attend a state-supported institution. The benefit is paid by SSACI to schools upon receipt of being billed. The 124 hours of aid benefit provided by this program represents any and all grant aid paid by the state of Indiana no matter the source but is separate and distinct from any federal Veteran benefits; applications for those benefits should be made to the U.S. Department of Veterans Affairs. To be eligible applicants must maintain Satisfactory Academic Progress (SAP) as determined by the college; not be in default of a student loan, annually file the appropriate (and error-free) academic year's (AY) Free Application for Federal Student Aid (FAFSA) - for example, file a 2009-2010 FAFSA for the 2009-2010 AY, a 2010-2011 FAFSA for the 2010-11 AY, etc. And be either: A. A pupil of the Indiana Soldiers' and Sailors' Children's' Home and was admitted to the Soldiers' and Sailors' Children's Home because the person is related to a member of the United States armed forces (who must be identified at the time of admission); Or B. Declared as a resident of the State of Indiana eligible for Indiana in-state tuition, and whose natural or legally adoptive parent: 1. Was/has been a legal resident of and domiciled in Indiana (e.g., filed state income taxes) for 36 consecutive months, And 2. Served in the Armed Forces of the United States from: April 6, 1917 ­ November 11, 1918; December 7, 1941 ­ December 31, 1946; June 27, 1950 ­ January 31, 1955; August 5, 1964 ­ May 7, 1975 August 2, 1990 - present, And 3. Sustained a service-connected death or disability as evidenced by the records of the United States Department of Veterans Affairs, or received wounds as a result of enemy action and/or received the Purple Heart Medal; and 4. Was discharged under conditions other than dishonorable. Courses must be for college credit. Only the institutions listed on this application are eligible for this benefit. Eligibility is not limited by age of the applicant and can be used for undergraduate or graduate study; however, tuition and regularly assessed fees for graduate students1 will only be paid at the undergraduate rates charged by the school. FREE TUITION FOR CHILDREN OF INDIANA POW/MIA'S IN VIETNAM Indiana provides educational benefits for children of veterans classified as Prisoners of War or Missing in Action after January 1, 1960. The benefit provides free tuition to attend an Indiana public institution as defined by the Commission. To be eligible the applicant must be: A. The child of a person who was: 1. A resident of Indiana at the time of entrance on active duty in the U.S. Armed Forces; and 2. Has been declared a Prisoner of War or Missing in Action after January 1, 1960; and B. Was born before or during the time his/her parent was classified POW/MIA; or 1. Was legally adopted or in legal custody of the father or mother prior to and during the time of classification as a POW/MIA. Eligible applicants who meet the admission requirements of the colleges listed on the Application for Remission of Fees for a Child of a Disabled Veteran or Remission of Fees for Children of POW/MIA are entitled to obtain a bachelor's degree or a Certificate of Completion from an Indiana public college free of tuition. HOW TO APPLY FOR BENEFITS File a current year Free Application for Federal Student Aid (FAFSA) Mail your Application for Remission of Fees for a Child of a Disabled Veteran or a POW/MIA to: Indiana Department of Veterans Affairs 302 West Washington Street, Room E-120, Indianapolis, IN 46204-2738

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The state may not remit tuition for terms completed prior to the filing of an error-free FASFA or the application for the benefit. The period of service, disability, and status will be verified and the application returned to the student. Present the verified application to the Financial Aid Office at the appropriate college. The student and /or veteran (if living) must provide the state any relevant information including but not limited to three years worth of Indiana state income tax returns. Questions on eligibility should be directed to the Indiana Department of Veterans Affairs, 317/232-3910 or 800/400-4520, or FAX at 317/232-7721, all questions on fee remission payments, including an historical account of hours used under the program, should be directed to SSACI at 317/232-2350. Those who were enrolled in graduate study during the spring 2008 term will continue to receive remission of actual tuition and fees until they graduate or stop out of college for two consecutive semesters; else all others who apply are considered "new" applicants.
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FILING INSTRUCTIONS
REMISSION OF FEES FOR THE CHILD OF A DISABLED INDIANA VETERAN Note: All applicants must file the appropriate year's Free Application for Federal Student Aid (FAFSA), preferably by the state of Indiana's March 10 (date received) filing deadline. Applicants can file the FAFSA online at www.FAFSA.ed.gov. By filing the FAFSA, applicants are applying for other financial aid that could be awarded in conjunction with fee remission benefits. This application must be completed in INK else it will be returned without verification. Veteran Data: 1. Fill in as completely as possible (lines 1 through 7). 2. Question #2, Social Security Number or VA File number must be included to search records for verification. 3. Question #5, Dates of Service (Active Duty Only). 4. Line 7 must be checked or application will be returned without processing. Student Data: 1. Fill out all lines completely and PRINT CLEARLY! Applications will be returned unapproved if any question is left unanswered. 2. List the college the student will attend. The student should be accepted by school prior to application. Your application will be mailed to the address provided. Verification: Do not write in this area; verification is completed by the Indiana Department of Veterans Affairs (IDVA). After the application is approved by IDVA, submit it to your college's financial aid office for processing. The List of Eligible Institutions The following state supported colleges are the only postsecondary institutions that qualify for the remission of fees program.
School Ball State University Indiana State University IU Bloomington IU East IUPU Indianapolis IUPU Columbus IU Kokomo IU Northwest IU South Bend IU Southeast Code 001786 001807 001809 001811 001813 E01033 001814 001815 001816 001817 School Purdue University, West Lafayette Purdue North Central Purdue Calumet Indiana Purdue Fort Wayne IVY Tech Bloomington IVY Tech Columbus IVY Tech Evansville / Tell City IVY Tech Fort Wayne IVY Tech Gary / Valpo. / E. Chicago IVY Tech Indianapolis Code 001825 001826 001827 001828 035213 010038 009925 009926 010040 009917 School IVY Tech Kokomo / Logansport / Wabash IVY Tech Lafayette / Crawfordsville IVY Tech Madison / Lawrenceburg IVY Tech Muncie / Anderson / Marion IVY Tech Richmond / Connersville IVY Tech Sellersburg IVY Tech South Bend / Warsaw / Elkhart IVY Tech Terre Haute / Greencastle University of Southern Indiana Vincennes University Code 010041 010039 009923 009924 010037 010109 008423 008547 001808 001843

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Students must notify IDVA and file a new application for tuition remission/grants every time they change colleges. Students must file a new application for this benefit if they stop out of college for two or more semesters or at the request of the college, IDVA, or SSACI. Students who stop out of college for two or more semesters are considered "new" applicants for the purposes of this program and as such are covered by the terms that apply to all new applicants. Applicants entitled to receive tuition remissions/grants must be admitted and enrolled at one of the institutions listed above. Indiana Department of Veterans Affairs 302 West Washington Street, Room E-120, Indianapolis, IN 46204-2738

Mail the completed application to:

The veteran's period of service, disability, discharge status and related information insofar as eligibility for this program is concerned will be verified and the application will be returned to the student by IDVA as either approved or denied. Present the verified application to the Financial Aid Office at the appropriate college. Questions should be directed to the Indiana Department of Veterans Affairs, 317/232-3910 or 800/400-4520, or FAX at 317/232-7721. This form cannot and will not be returned to the Student/Veteran by FAX.

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