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Kentucky Tuition Waiver Application 2022
KENTUCKY DEPARTMENT OF VETERANS AFFAIRS
TUITION WAIVER APPLICATION
Applicant Data
1.
First Name Middle Last Name
2.
Address City
State/Zip Code
3.
Date of Birth Soc Sec# #Telephone
What is your relationship to the veteran? (Specify:
Child**Stepchild, Spouse, and Widow/er)
Attach appropriate documentation: birth certificate, marriage certificate, **stepchild affidavit required or Chapter 35
Award Letter.
4.
Are you a Kentucky resident? Did/do you reside in the veteran’s household?
5.
Name of College or University
Campus
Location
6. Anticipated enrollment date (or original date of enrollment if already enrolled)
7.
Have you or any member of the veteran’s family previously been issued a Tuition Waiver Certificate? Yes☐No☐
8.
If yes, Certificate Number Family Member Name
9.
If spouse of deceased veteran, are you remarried? Yes☐ No☐
10: Applicant E-MAIL ADDRESS? @ * REQUIRED*
10.
Parent E-mail Address? @
Disabled Veteran Information *KY Residency required*
1.
First Name Middle Last Name
2.
Address City
State/Zip Code
3.
Telephone Date of Birth
KY Resident?
4.
Soc Sec # VA File #
5.
Home of Record at time of entry into service _ (Attach DD214.) * required*
6.
Dates of Service Character of Service:
** You MUST attach a copy of Disability award letter from the Department of Veterans Affairs**
Deceased Veteran
1.
First
Name
Middle
Last Name
2.
Last Known
Address:
City
State/Zip Code
3.
Date of Birth
Date of Death
(
Attach death certificate
.)
4.
State Residence at time of death
Was his/her death Service connected?
5.
Soc Sec #
VA File# Service #
6.
Home of Record at time of entry into service
(
Attach DD214 if applicable
.)
7.
Dates of Service
Character of Service:
8. Died on Active Duty?
☐
Yes
☐No (If yes, attach casualty report.)
9.
Was the veteran totally disabled at time of death?
☐
Yes
☐No
10. Was the veteran receiving VA disability at time of death?
☐
Yes
☐
No (
attach award letter
.)
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Kentucky Tuition Waiver Application 2022
Applicant
I hereby certify, under penalty of law, that the information given in this application is correct and complete to the best of my
knowledge. I am aware that, should investigation at any time show falsification, I will not be considered for tuition waiver or,
if already receiving tuition waiver, I will be disqualified from future eligibility. I hereby authorize the Kentucky Department of
Veterans Affairs and agencies to which my name is certified/ referred to make all necessary investigations concerning me,
my status, eligibility, or my action in any transaction. I authorize the Kentucky Department of Veterans Affairs to receive and
make
available to state institutions of higher education my records attached in support of this application, and further authorize
and request each institution, agency or organization to provide all information that may be sought in connection with my
application. I understand and agree that I will be required to ratify the information contained in this application by signature
below as a condition of eligibility. I understand that this application is to determine eligibility for tuition waiver provided by the
Commonwealth of Kentucky under Kentucky Revised Statutes. I understand that certification of eligibility is made only by the
Kentucky Department of Veterans Affairs.
Signature Student Applicant Date Signed
Check list of REQUIRED Documentation
(If documents are missing this will delay and possibly deny your application for the tuition waiver)
1. ☐Applicant Birth certificate showing veteran as parent.
2. ☐Marriage Certificate for Spouse, Widow, Widower
3. ☐Step Child Affidavit must be completed and signed by veteran
4. ☐Copy of Veterans DD-214
5. ☐Copy of Veteran’s Kentucky State Driver’s License or other proof of residency such as a property
tax bill, current utility bill.
6. ☐ Disability award letter issued within the last year showing 100% service connection or
eligibility of Unemployability.
7. ☐ Pension award letter
8. ☐ If Veteran is deceased, attach a copy of Death Certificate, Causality report or award letter.
You must submit your completed application in a PDF FORMAT via email to:
KDVA.TUITIONWAIVER@KY.GOV
If you need assistance or have questions concerning the State Tuition Program please call (502)
782-5734 or (502) 564-9203
Incomplete documentation could result in severe delay or denial of application
