AB 13 VACA AFFIDAVIT

California Nonresident Tuition Exemption Request Eligible Veterans and Dependents.

Please submit form to Enrollment Services on East Campus.

Student Name: ______Student W#:______

FirstMiddle Last

Telephone Number: ______Term/ Year:  Spring ______ Fall ______ Summer _____

STUDENT MUST MEET ONE OF THE ELIGIBILITY REQUIREMENTS (Ed Code 68075)

  • A Veteran who lives in the state of CA in which the institution of higher learning is located (regardless of his/her formal state of residence) and enrolls at MJCwithin three years of discharge from a period of active duty service of 90 days or more with a character of discharge other than bad conduct or dishonorable.
  • A spouse or child using transferred benefits who lives in the state of CA in which the institution of higher learning is located (regardless of his/her formal state of residence) and enrolls at MJC within three years of the transferor’s discharge from a period of active duty service of 90 days or more with a character of discharge other than bad conduct or dishonorable.
  • A spouse or child using benefits under the Marine Gunnery Sergeant John David Fry Scholarship who lives in the state of CA in which the institution of higher learning is located (regardless of his/her formal state of residence) and enrolls at MJCwithin three years of the Service member’s death in the line of duty following a period of active duty service of 90 days or more.
  • A student who initially met the requirements above will maintain “covered individual” status as long as they remain continuously enrolled at MJC, even if they are outside the three-year window or enroll in multiple programs.
  • The student must this submit this form along with the proper documentation prior to the residency deadline that is specified on the Residency Consideration form. It will take approximately 5-7 business days to process your documentation.

The student must complete and submit this form and provide proof of eligibility based upon student’s status:

STATUS / DATE / BENEFIT ELGIBILITY / REQUIRED DOCUMENTATION / STUDENT INITIALS
Veteran / Date of Discharge from active duty service of 90 days or more:
______/ Chapter 30 GI Bill
Chapter 33 Post 9/11 / 1.VA Certificate of Eligibility &
2. DD-214 Member 4 / ______
Child
Spouse / Date of Discharge from active duty service of 90 days or more:
______/ Chapter 33 Post 9/11 GI Bill Transferred of Entitled Benefits / 1.VA Certificate of Eligibility & transferred benefits &
2. DD 214 Member 4 / ______
Child
Spouse / Date of service members passing:
______/ Marine Gunny Sergeant John David Fry Scholarship / 1.VA Certificate of Eligibility / ______

I declare under penalty of perjury under the laws of the State of California that the information I have provided on this form is true and accurate. I understand that this information will be used to determine my eligibility for the nonresident tuition exemption under Section 702 of the Veterans Access, Choice and Accountability Act of 2014. I further understand that if any of the above information is untrue, I will be liable for payment of all nonresident charges from which I was exempted and may be subject to disciplinary action by the MJC.

Student Signature______Date: ______

FOR OFFICIAL USE ONLY

Status:
Approved
Denied
No Action / Documentation:
DD-Form 214 Member 4
Certificate of Eligibility
CA DL/ID / VACA Eligibility:
Character of Discharge: ______
Date of Separation: ______
Expiration: ______