Veterans - California College Fee Waiver

CALIFORNIA DEPARTMENT OF VETERANS AFFAIRS

COLLEGE FEE WAIVER PROGRAM FOR VETERAN DEPENDENTS - First Time Applicants
I. STUDENT INFORMATION
Student's Last Name:*
Student's Last Name:
Student's First Name:*
Student's First Name:
Student's Middle Initial:
Student's Middle Initial:
Student's Social Security Number:*
Student's Social Security Number:
Student's Date of Birth*

MonthDayYear
MarriedSingle
Student's Address*

Street Address

Street Address Line 2

CityState

Zip
Student's Telephone Number:*
Phone NumberFormat: (000) 000-0000.
Student's E-mail*
example@example.com
Adopted ChildStepchildSpouseSurviving SpouseBiological Child
YesNo
VA EDUCATIONAL BENEFITS UNDER CHAPTER 35
YESNO
YesNo
ADJUSTED GROSS INCOME (AGI) of student from last year (January 1st through December 31st):*
ADJUSTED GROSS INCOME (AGI) of student from last year (January 1st through December 31st):
ANNUAL VALUE OF ANY SUPPORT RECEIVED FROM A PARENTS*
ANNUAL VALUE OF ANY SUPPORT RECEIVED FROM A PARENTS
"NOTE: Examples of support include, but are not limited to: college housing, transportation books, school supplies, medical care etc. Under plan B, the total amount of the child's income and value of support. as listed above, cannot exceed the "national poverty level" as determined by the U.S. Census Bureau and published by the California Department of Veterans Affairs Refer to "Who May Apply Under Plan B" on the next page for required statements, if you entered zero on AGI and Annual Value of Support.
II. SCHOOL INFORMATION
CALIFORNIA COLLEGE or UNIVERSITY you are attending or plan to attend*
CALIFORNIA COLLEGE or UNIVERSITY you are attending or plan to attend
ACADEMIC YEAR for which you are requesting walver of tuition/fees*
ACADEMIC YEAR for which you are requesting walver of tuition/fees
III. VETERAN'S INFORMATION
Veteran's Last Name (Served Under if Currently Different):*
Veteran's Last Name (Served Under if Currently Different):
Veteran's First Name:*
Veteran's First Name:
Veteran's Middle Initial*
Veteran's Middle Initial
Veteran's Social Security Number of VA Claims Number:*
Veteran's Social Security Number of VA Claims Number:
Date of Birth*

MonthDayYear
Date of Death (if applicable)

MonthDayYear
Branch of Military Service:
*
Dates of Your Active Duty Military Service:
FROM:*

MonthDayYear
Until:*

MonthDayYear
Address*

Street Address

Street Address Line 2

CityState

Zip
Veteran's Telephone Number:*
Phone NumberFormat: (000) 000-0000.
Veteran's E-mail:*
example@example.com
If the veteran is alive, what is the veteran's current "service-connected" disability rating adjudicated by either the US Military or the US Department of Veterans Affairs? Text Field%.
YesNo
I hereby certify under penalties of perjury that the information contained in this application and supporting documents is given for the purpose of obtaining educational benefits and is true, correct, and complete. I authorize the California Department of Veterans Affairs (CalVet) employees, officers, and designees to verify these documents. I hereby authorize the U.S. Department of Veterans Affairs, Department of Defense, Internal Revenue Service, and the Franchise Tax Board, to release information regarding my service-connected disability rating and/or income to CalVet with the understanding that the department will keep such information confidential. I hereby authorize the release of my CalVet College Fee Waiver Program for Veterans Dependents award letter to the College or University for which I am applying. I understand that educational benefits may be denied or found to be my responsibility to repay if any information is found to be false, intentionally incomplete, or misleading.
Signature of VETERAN*

Clear
Signature of Veteran
Signature*
Date*

MonthDayYear
(If veteran is unable to sign, parent/veteran spouse must complete and attach a VSD-021)
Signature of STUDENT*

Clear
Signature*
Date*

MonthDayYear
YesNo
Upload Veteran's DD-214*

PDF Files Only
Cancelof
Upload Veteran's Award Letter*

PDF Files Only
Cancelof
Upload Signed Copy of Student's Tax Return*

PDF Files Only
Cancelof
Upload Student's Birth Certificate*

PDF Files Only
Cancelof
Should be Empty:

CALIFORNIA DEPARTMENT OF VETERANS AFFAIRS

I. STUDENT INFORMATION

II. SCHOOL INFORMATION

III. VETERAN'S INFORMATION

Signature of Veteran