Form Isac F103 – Fill Out and Use This PDF

	1755 Lake Cook Road
Illinois	Deerfield, IL 60015-5209
Student	800.899.ISAC (4722)
Assistance	E-mail: collegezone@isac.org
Commission

ILLINOIS VETERAN GRANT (IVG) PROGRAM APPLICATION

WARNING: Any person who knowingly makes a false statement or misrepresentation on this application shall be subject to prosecution to the fullest extent of the law.

Data may be verified with appropriate authorities of federal and state agencies.

Please print legibly in ink or type. Before completing this application, read both pages and gather all required documentation. Allow at least four weeks for processing of this application.

Are you residing in Illinois?		If No, State in which you are currently residing:
Yes	No	Also if “No”, you must provide documentation specified under Eligibility Requirements on page 2, item 3.

Applicant’s Federal Active Duty Service Information

Refer to your Department of Defense (DOD) Certificate of Release or Discharge from Active Duty (DD214 Member 4 or equivalent copy) to complete this section.

1.

Dates of initial federal active duty service

From:

/

/

To:

/

/

month/day/yearmonth/day/year

If you reenlisted, extended, or were called to federal active duty from a Reserve component of the Armed Forces of the United States or Illinois National Guard, list the most recent period of additional federal active duty service

From:

/

/

To:

/

/

month/day/yearmonth/day/year

2.Are you currently serving on federal active duty as a member of the Armed Forces of the United States? (see page 2, item 1 under Eligibility Requirements for

definition) (see note under Application Procedures on Page 2)

Yes

No

3.Were you called to federal active duty from a Reserve Component of the Armed Forces of the United States or the Illinois National Guard?

Yes No

If you answered “Yes” to 2 and “Yes” to 3 above you must submit a letter from your Commanding Officer*. Also, if you had a break in service you must submit a DD214 Member 4 or equivalent Department of Defense (DOD) documentation for each period of federal active duty service.

If you answered “Yes” to 2 and “No” to 3 above you must submit a letter from your Commanding Officer * and a copy of the Enlistment/Re-enlistment document confirming enlistment and/or extension agreements for all periods of enlistment/re-enlistment/extension. (Commissioned officers must submit their “Officer Appointment Acceptance and Oath of Office” document). Also, if you had a break in service you must submit a DD214 Member 4 or equivalent Department of Defense (DOD) documentation for each period of federal active duty service.

If you answered “No” to 2 and “Yes” or “No” to 3 above you must submit a DD214 Member 4 or equivalent DOD documentation for each period of federal active duty service.

*The letter from the Commanding Officer (on departmental letterhead) must indicate you are a member of the Armed Forces of the United States, your character of service, your home of record at the time of original enlistment, your length of service and the expiration date of your current enlistment.

Please note: A DD214 Member 1 or Worksheet is not equivalent to the DD214 Member 4. If the DD214 Member 4 lists prior federal active duty service, a DD214 Member 4 or equivalent must be submitted for each period of federal active duty service.

4.	Have you previously applied for or used the Illinois Veteran Grant?	Yes	No
5.	Were you an Illinois resident at the time of both entering and leaving federal active duty service?	Yes	No

If “No”, or if your DD214 Member 4 or equivalent DOD documentation does not verify residency by indicating home of record as “Illinois,” you must provide documentation specified under Eligibility Requirements on page 2, item 3.

6.Answer the following only if you served less than one year of federal active duty service:

a. Were you separated for medical reasons directly connected with your service?

Yes

No

(If “Yes” to question 6a, you must attach an Armed Forces of the United States Medical Review Board Statement or equivalent DOD documentation).

b. Were you separated prior to August 11, 1967?	Yes	No
c. Did you serve in a foreign country in a time of hostilities in that country?	Yes	No
(If “Yes” to question 6c, this must be indicated on DD214 Member 4 or equivalent DOD documentation.)

Sign and date this certification section:

I certify, under the penalties of perjury as provided by law, that all information on this application, and the required documentation submitted with the application, is true and correct. I have read both pages of this application and have attached all required documentation before signing it. I certify that I do not owe a refund on any federal or state grant. I understand that I must establish satisfactory repayment arrangements if I am in default on any federal student loan. I certify that I am in compliance with federal Selective Service registration requirements. Further, I give my consent to the federal and state departments of Veterans’ Affairs, the Armed Forces of the United States, National Guard, Reserves, federal Selective Service, and the institution I attend to release information to the ISAC concerning my eligibility for the Illinois Veteran Grant (IVG) Program. I certify that this is a true and original application form provided by ISAC.

Applicant’s Signature

Date

FOR ISAC USE ONLY

ISAC #F103 07/05

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Printed by authority of the State of Illinois

ILLINOIS VETERAN GRANT (IVG) PROGRAM APPLICATION

ELIGIBILITY REQUIREMENTS

1.Applicants must have served federal active duty in the Armed Forces of the United States. The term “Armed Forces of the United States” shall be defined as the United States Army, Air Force, Navy, Marines and Coast Guard.

If the applicant applies while serving in the Armed Forces of the United States and is designated as a qualified applicant, he/she must reapply upon separation.

Members of the Reserve Officer Training Corps (ROTC) are not eligible. Applicants are not eligible if their only service has been attendance at a service academy.

2.Required federal active duty service criteria:

a.Each period of service must be characterized as honorable.

b.Have at least one year of federal active duty in the Armed Forces of the United States, unless he/she:

•Was medically discharged and the medical reason for discharge was service related, or

•Was discharged prior to August 11, 1967, or

•Served in a foreign country in a time of hostilities in that country.

3.Required Illinois residency criteria:

a.Must have been a legal resident physically residing in Illinois within six months prior to entering the Armed Forces of the United States; and

b.Must have physically returned to Illinois and established residency within six months of leaving such service; and

c.Must reside in Illinois unless he/she is a member of the Armed Forces of the United States at the time of enrollment in school; or

d.If the applicant does not meet the criteria indicated in item(s) 3b and/or 3c because he/she is married and resides with a spouse who is currently serving in continued military service outside of Illinois, the applicant must submit a copy of the spouse’s orders spanning the period of time required to meet Illinois residency criteria. (If spouse has been discharged, a copy of his/her DD214 may be required to show mailing address after separation.)

Proof of Illinois residency is required if the veteran’s home of record on the DD214 Member 4 or equivalent DOD documentation prior to entry is other than Illinois, or if the veteran’s mailing address upon separation is other than Illinois. These documents must have been issued/dated within the relevant six months prior to the date entered into service and/or within six months after the date of separation (or spouse’s separation if applicable). The following list contains examples of acceptable documents.

•	Illinois Driver’s License	•	Statement of benefits history from the Illinois Department of Public
•	Illinois identification card	•	Aid
•	Illinois high school or college transcript		Illinois Department of Employment Security Statement of Benefits

•Utility bill in the applicant’s name

4.The applicant must not owe a refund on a federal or state grant, and must meet or otherwise be exempt from federal Selective Service registration requirements.

A qualified applicant in default on any federal student loan shall be permitted one term of assistance, during which a satisfactory payment record must be established. If such a repayment record is not established, additional assistance shall be denied until a satisfactory repayment record is established. To establish repayment arrangements on a defaulted loan guaranteed by the Illinois Student Assistance Commission (ISAC), call 800.934.3572.

BENEFITS AND ELIGIBLE COLLEGES

This program pays eligible tuition and allowable fees at any Illinois public college or community college. Qualified applicants may use this grant at the undergraduate or graduate level for the equivalent of four academic years of full-time enrollment. Contact the financial aid office at your college to determine what portion of your total tuition and fees will be covered by this grant.

APPLICATION PROCEDURES (prior versions of this application will only be accepted if all pertinent information is provided)

Please note: If the DD214 Member 4 lists prior federal active duty service, a DD214 Member 4 or equivalent must be submitted for each period of prior

federal active duty service. Also please note: an applicant currently serving on federal active duty must provide proof of continuing federal active duty service when his/her current enlistment expires and reapply after discharge from federal active duty service. Any needed corrections to the DD214 Member 4 must be completed before submitting the application.

Applicants must complete this application and supply the required documents. Applicants should keep a copy of the completed application and documents. Allow at least four weeks for processing of the application. Incomplete applications and/or missing documentation will delay an eligibility decision.

ISAC will send qualified applicants a “Notice of Eligibility.” It is important to keep a copy of the notice in order to present a copy to the school as needed. Qualified applicants must notify their college’s financial aid office of their eligibility status as soon as possible, but not later than the last scheduled day of classes for the term for which a grant is requested.

TO OBTAIN AN EQUIVALENT COPY OF YOUR DEPARTMENT OF DEFENSE DD214 MEMBER 4

Write to the Illinois Department of Veterans’ Affairs, P.O. Box 19432, Springfield, Illinois 62794-9432 or phone 217.782.4652; or write to the National Personnel Records Center, Military Personnel Records, 9700 Page Blvd, St. Louis, Missouri 63121 (Web site: vetrecs.archives.gov). Reserve and National Guard members may also contact their unit’s chain of command for assistance regarding additional equivalent documentation, such as a Reserve Retirement Points Statement or NGB22 or 23.

FOR ASSISTANCE

If you have questions, or to learn more about the financial aid process and available programs, visit us at collegezone.com, call an ISAC College Zone Counselor at 800.899.ISAC (4722), or send an e-mail message to collegezone@isac.org.

MAIL TO: D-3A IVG PROCESSING, ISAC, 1755 LAKE COOK ROAD, DEERFIELD, IL 60015-5209

ISAC #F103 07/05

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Printed by authority of the State of Illinois