Form Hazlewood – Fill Out and Use This PDF

Texas Higher Education Coordinating

Board

(512)427-6340

(800)242-3062

www.collegeforalltexans.com

Hazlewood Exemption Application Packet for Eligible Children and Spouse of Texas Veterans (HE-D)

The HE-D application is for eligible children and spouses of veterans who wish to apply for the Hazlewood Exemption or for children to whom hours have been transferred through the Legacy Program.

*Contact your institution to find out where and when you should submit the application and supporting documentation. The institution will process your application accordingly. Do NOT mail the application to the Texas Higher Education Coordinating Board.

HE-D, rev 09/2012

Hazlewood Exemption Application Packet for

Eligible Children and Spouse of Texas Veterans

Eligibility Requirements and Documentation

In order to qualify for a tuition and partial fee exemption through the Texas Education Code 54.341 (known as the Hazlewood Act), the child or spouse of certain deceased or disabled Texas member of the Armed Forces or Texas National Guard must meet all program requirements.

The following is a list of program requirements and how they are documented.

Eligibility Requirements	Questions	Documentation
Dependent child or spouse is a	N/A	Institution’s classification as a resident by the
resident of Texas at the time he/she		registrar or admissions office.
uses the exemption.
Dependent child or spouse is not in	Question 6	Children or spouse of veterans having with loans
default on a loan made or		made through the Texas Higher Education
guaranteed by the state of Texas;		Coordinating Board must log into
includes College Access Loan (CAL),		www.HHLoans.com and print the page showing
Health Education Loan (HELP),		their loan status to provide to the institution.
state’s Stafford Loan and Texas B-		Applicants without a loan with THECB will be
On-Time Loan Program (BOT).		verified by the institution and the CB.
Federal loans are not included.
If eligible for federal veteran’s	Question 7	Benefit letter from VA Education Center in
education benefits under Ch. 33 Post		Muskogee, Oklahoma, 1-888-GI-Bill-1 or 1-888-442-
9/11 GI Bill or Ch. 31 Voc. Rehab,		4551 or www.gibill.va.gov .
the value of these benefits cannot
exceed the value of the Hazlewood
exemption.
Veteran died or is rated totally	Question 12	DD1300 issued by the Department of Defense (if
disabled for purposes of		parent died while still in the service); letter from VA
employability as a result of		if parent died after discharge.
illness/injury related to service.		Ratings Disability letter from VA if parent is rated as
		unemployable.
If a child, proof that he or she was	Question 13	Copy of a birth certificate or tax return indicating
a dependent on or after the date the		dependency on or after the time the parent died or
veteran parent died or sustained the		became disabled.
disabling injury or was declared by		Note: Effective Fall 2011, all children applying for
VA as unemployable because of the		the exemption for the first time must be 25 or
injury.		younger.
If a spouse, proof that he or she is	Question 14	Copy of the legal marriage certificate or tax return
the disabled veteran’s spouse.		indicating the marriage status with the veteran.
Veteran parent or spouse (at the	Questions 15	DD214 shows “place of entry” and “home of record
time of service entry):	and 16	at time of entry” boxes. The Hazlewood
1. entered the service in Texas,		administrator will review this document. If the
2. declared Texas as his or her		DD214 shows HOR and Place of Entry were not
home of record, or		Texas, applicant must complete the Hazlewood
3. was a resident of Texas		Residency Questionnaire and submit with the
		Application. A copy of the Questionnaire is included
		in this packet.
		HE-D, rev 09/2012

Documents to Submit

To apply for a Hazlewood Exemption, you must submit the following documents to your institution:

1.The Hazlewood Exemption Application for Eligible Dependents of Texas Veterans Who have

Never Used the Exemption (HE-D) – This application (HE-V) – Application for Veterans

2.If your parent or spouse died while in service,

DD1300 – for use in verifying your parent’s place of entry, and that his/her death was service- related.

3.If your parent or spouse died after discharge as a result of service-related illness or injury, DD214 – to verify parent’s place of entry

Letter from VA – to confirm death was related to service

4.If your parent or spouse became unemployable due to military service-related illness or

injury,

Ratings Decision Letter – to confirm the parent or spouse is considered to be totally disabled with respect to employability.

5.Benefits letter from Muskogee, Oklahoma– to verify the value of your CH 33 or CH 31 federal veteran’s education benefits. Obtain a benefits letter from VA Education Center in Muskogee, Oklahoma. 1-888-GI-Bill-1 or 1-888-442-4551 or www.gibill.va.gov

6.Hazlewood Residency Questionnaire for Dependent Children and Spouse of Veterans –ONLY if your answers to both 14a and to 14b on the application were “no”.

7.Proof of Online Database Registration – All applicants (veteran and dependents) must register online in order to track hours used through the program. Once registered applicants must login and print a verification page for the institution. https://www1.thecb.state.tx.us/apps/hsh/students/

The easiest way to acquire a copy of the DD214 or DD1300 is to contact the VA regional office in Waco or Houston, whose addresses are:

Houston Regional Office	Waco Regional Office
6900 Almeda Road	One Veteran Plaza
Houston, TX 77030-4200	701 Clay Avenue
1-800-827-1000	Waco, TX 76799
713-383-5340	1-800-827-1000
	254-299-9774

To receive a copy of the Ratings Decision Letter, contact the Waco Regional Office.

HE-D, rev 09/2012

HAZLEWOOD EXEMPTION (HAZLEWOOD ACT)

APPLICATION FOR CHILDREN AND SPOUSE OF ELIGIBLE

VETERANS

Each child or spouse wishing to receive an exemption through the Hazlewood Act (Texas Education Code 54.341) must complete and sign the following application, complete the HE-V application, and provide his/her institution documentation of eligibility as indicated below.

Mail this application and all documentation to your institution’s veteran’s education office or financial aid office.

Part A – Basic Eligibility – Child or Spouse

1. Name: _____________________________________ 2. Date of Birth: ______________________

3.Social Security Number: _____________________________________________________________

4.Address: __________________________________________________________________________

				Street			City	State	Zip Code
5.	Term for which you are applying for the exemption: ___________________								/__________________
								(fall, spring, or summer) / year
6.	Are you currently in default on an education loan made or guaranteed by the state of Texas?
	[	]	yes	[	]	no NOTE: This will be verified by your institution.
7.	Are you currently eligible to receive benefits under Title 38, United States Code, Chapter 33 or Ch. 31?
	[	]	yes	[	]	no
8.	Are you applying as a child or spouse of a Texas service member?
	[	]	child of Texas service member				[ ]	spouse of Texas service member

∙If you are a child who is receiving “transferred” LEGACY hours for the first time, complete Part B only; and go to Part E- Certification and Consent to Disclosure

∙If you are a spouse or child of a deceased, disabled, or MIA veteran applying for the “first time” for your own set of Hazlewood hours to be exempted, complete Part D only; and go to Part E- Certification and Consent to Disclosure.

∙If you are a spouse or child of a veteran who has “previously received” the Hazlewood Exemption hours complete part C only and go to Part E- Certification and Consent to Disclosure.

Part B- Child Receiving Transferred Hours (Legacy) – Veteran must file HE-V application

*Hours can only be transferred to one child at a time up to 150 hours.

9.Veteran parent from whom you received a transfer of unused Hazlewood hours:

Name:_____________________________________ SSN:_________________________________

Page 1 HE-D, rev 09/2012

Part C – Spouse or Child who has Previously Received Exemption

If applying as the child or spouse of a service member:

Name of service-member parent/spouse: __________________________ SSN:____________________

10.Last term in which you used the Hazlewood exemption: ___________________/__________________

(fall, spring or summer) / year

11.Name (not initials) of all the schools where you have used it:

_______________________________________________________________________________________

_______________________________________________________________________________________

Part D – Spouse or child applying for exemption for 1st time.

12. Deceased or disabled Parent or Spouse:

Name: ___________________________________________ SSN: _____________________________

13.If you are a veteran’s child, is the veteran’s name on your birth certificate or were you claimed as a dependent for income tax purposes by your parent in the year in which he/she died or became disabled due to injuries sustained while in the service or in the year in which the injuries occurred that resulted in unemployability?

[ ] yes [ ] no [ ] n/a

14. Are you the spouse of a veteran who died, went missing in action, or became 100% disabled for the

purpose of employability due to injuries sustained while in the service?

[ ] yes

[ ] no

15.At the time your parent or spouse entered the service, did either of the following circumstances apply to him or her?

a. Was his or her place of entry Texas?

b. Did your parent or spouse declare Texas as his or her Home of Record?

16. If you answered “no” to 15(a) and 15(b), was your parent or spouse a Texas resident when he or she

entered the service?

[ ] yes

[ ] no

If you answered “no” to 15(a), 15(b), and 16, you are not eligible for a Hazlewood exemption.

If both of your answers to question 15 are “no” but you can answer “yes” to question 16, submit this application along with a completed copy of the Hazlewood Residency Questionnaire for Veterans, which is included in this application packet along with supporting documentation. The Residency Questionnaire is NOT required for persons who answered “yes” to 15a or 15b.

Page 2 HE-D, rev 09/2012

Part E – Certification and Consent to Disclosure by Child or Spouse

My name is ________________________________ and I am applying for an exemption from payment of

tuition and certain fees under Texas Education Code, Section 54.341 (The Hazlewood Act). I understand that I may be entitled, under the law, to this exemption for up for 150 credit hours total at Texas public institutions of higher education. For the purpose of accounting for the total number of hours for which I receive this exemption, I am granting permission to any institution in which I have enrolled or will enroll to release current semester and historic credit hour information to the Texas Higher Education Coordinating Board ("Board") and am granting permission for the Board to share such data with any institution that I might attend. I hereby certify the information I have provided is true and correct. I understand that if I fail to provide accurate information, I may be required to reimburse the institution and penalties may be imposed.

______________________________________________	_________________
Signature of child or spouse	Date

TURN IN THIS APPLICATION ALONG WITH SUPPORTING DOCUMENTATION TO THE FINANCIAL AID OFFICE AT YOUR COLLEGE/UNIVERSITY.

For Institution Use Only

Approved (initials):

Muskogee letter on file?

Resident now?

yes [

]

no [

]

yes [

]

no [

]

Term VA benefit amount:

Dependency proof?

yes [

] no [

]

In default?

yes [

]

no [

]

$ __________________

Proof of marriage for spouses?

yes [

] no [ ]

HS 36 mo in TX?

yes [

] no [

]

Ratings Disability Letter indicates unemployability?

Yes [

] no [ ]

Place of entry TX? yes [

] no [

]

Parent’s or Spouse’s Residency Form supports residency?

Yes [

]

no [

]

n/a [

]

HOR Texas

yes [

] no [

]

Recipient’s relationship to the Texas

veteran?

Biological Child

[ ]

Adopted Child

[

]

Step-child

[ ]

Spouse

[ ]

Claimed as a dependent on income taxes

[

]

Page 3 HE-D, rev 09/2012

Dependent Children and Spouse of Veterans

Hazlewood Exemption Residency Questionnaire

This form is only required for individuals whose parent’s or spouse’s place of entry into the service was NOT Texas, and who did NOT declare their Home of Record as Texas at the time they entered the service. Do not complete this form if your place of entry or Home of Record at the time of entry into the service was Texas.

Part A – Applicant Identification

1. Name: _______________________________________ 2. Social Security Number ________________________

Part B – High School Graduation or Receipt of GED

1.Did your service-member parent or spouse graduate from a Texas high school or received a GED in Texas having lived in the state the 36 months leading up to graduation or receipt of the GED?

[ ] yes [ ] no

2. Did he/she live in Texas the 12 months prior to enlistment? (The year prior to enlistment may include time enrolled in

high school or completing the GED.)

[ ] yes

[ ] no

If you checked “yes” to BOTH questions, skip to Part G.

Part C – Parent’s Dependent Status at Time He/She Entered the Service

1. At the time he/she entered the service, which of the following circumstances applied to your parent or spouse? [ ] a. Filed his/her own federal income tax as an independent tax payer.

[] b. Was claimed as a dependent by a parent or court-appointed legal guardian.

c. If you did not check “a” or “b” above, who provided the majority of his/her support?

[	]	self	[ ] parent or guardian
[	]	other*:_________________________________________________________________________

If you checked “a” or “self” under “c”, continue to Part D.

If you checked “b” or “parent or guardian” under “c”, skip Part D and go to Part E.

If you checked “other” please explain below, skip Part D and answer Part E for the individual who provided your parent support.

Part D – For Those Whose Service Member Parent or Spouse Filed His/Her Own Income Tax (Checked “a” to Question C 1. above)

1.	Was your parent or spouse living in Texas when he/she entered the service? [		] Yes		[ ] No
2.	If he/she was living in Texas when he/she entered the service,
	a. how long had your parent or spouse resided in Texas at that time?			Yrs &		Mos

b.what was his/her MAIN reason for being in Texas? (If “other”, give explanation.)

[ ] Born & Raised Here [ ] Go to College

[ ] Accept a Job

Military Assignment

[] Other __________________________________________________________________________________

c. if it was for Military Assignment, what was his/her home of record? __________________________________

Page 1 HE-D, rev 09/2012

3. If he/she was not living in Texas when he/she entered the service,
a. how long had your parent or spouse resided outside of Texas at that time?				Yrs & _____Mos
b. what was his/her MAIN reason for being out of state? (If “other”, give explanation.)
[ ] Go to College [ ] Accept a Job	[ ] Military Assignment	[	] Other

c. if it was for Military Assignment, what was his/her home of record? ___________________________________

Part E – For Students Whose Service Member Parent or Spouse was a Dependent at the Time He/She Entered the Service. All students who answered “Parent” or “Legal Guardian” or “other” in Part C must

complete this section.

The following questions apply to the service member’s parent or legal guardian, which (for simplicity) we will refer to as your grandparent.

1.Name of grandparent who claimed your parent or spouse as a dependent at the time he/she entered the service:

_______________________________________________________

2. Relationship to your parent or spouse: [ ] parent [ ] legal guardian [ ] other ______________________

3.Was the grandparent a U.S. Citizen or Permanent Resident when your parent or spouse entered the service? If not, which of the following categories did he/she meet?

a. [ ] Applicant for Permanent Resident Status.

b. [	]	Foreign National with a visa to live in the United States. If you checked this box, what type of visa is it?
		Visa type: ____________
c. [	]	Foreign National without a visa.
4. If the grandparent was living in Texas when your parent or spouse entered the service,
a. how long had your grandparents resided in Texas at that time?				Yrs &		Mos

b.what was the grandparent’s MAIN reason for being in Texas? (If “other”, give explanation.)

[ ] Born & Raised Here

[ ] Go to College

[ ] Accept a Job

[ ] Military Assignment

[] Other ________________________________________________________________________

c. if it was for Military Assignment, what was his/her home of record? __________________________

5.If the grandparent was not living in Texas when your parent or spouse entered the service,

a. how long had the grandparent resided outside of Texas at that time?

Yrs &

Mos

b.what was his/her MAIN reason for being out of state? (If “other”, give explanation.)

[ ] Go to College [ ] Accept a Job [ ] Military Assignment [ ] Other

c. if it was for Military Assignment, what was his/her home of record? __________________

Part F – Comments

If there is additional information you believe your institution should have in order to determine your parent’s or spouse’s residence at the time he/she joined the service, please provide it here.

Page 2 HE-D, rev 09/2012