Form 37W R4 Request for Fee Waiver - Carson City, Nevada

Form 37W R4 or the "Request For Fee Waiver" is a form issued by the Nevada National Guard .

The form was last revised in July 1, 2005 and is available for digital filing. Download an up-to-date Form 37W R4 in PDF-format down below or look it up on the Nevada National Guard Forms website.

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Nevada National Guard
NEVADA NATIONAL GUARD
Education Officer
STATE EDUCATIONAL ENCOURAGEMENT FUND
2460 Fairview Drive
REQUEST FOR FEE WAIVER
Carson City, NV 89701-6807
(See Reverse for Instructions)
(775) 887-7258/7279
FAX: (775) 887-7279
PART A -- PERSONAL INFORMATION
1a. Name (Last, First, MI)
1b. Rank 1c. SSN
1d. Unit
1e. ETS Date:
1f. Affiliation (circle one) :
Army
Air
1g. Status (circle one ):
Technician
AGR
Traditional
2a. Mailing Address
2b. Home Phone:
Street or Box
2c. Work Phone:
City, State, Zip
2d. Cell Phone:
PART B -- EDUCATION INFORMATION
3. Degrees Held
4. Degree Sought
5.
UCCSN Institution (circle one ):
NONE
NONE
AA
AA
UNR
UNLV
NSC
TMCC
WNCC
CCSN
GBC
AS
AS
6.
Total Credit Hours Enrolled ___________________________
BA
BA
Term (circle one) :
Fall
Spring
BS
BS
Year ____________
MA
MA
7.
I have been counseled by my unit commander relative to the reasons for termination of my
MS
MS
eligibility under the Nevada National Guard Education Program and understand that I must
remain a member of the Nevada National Guard in good standing throughout the semester
MBA
MBA
attending and achieve at least a 2.0 GPA for the semester or I will be held liable to the Board of
Regents for all fees waived by the university or college. If I am a recruit who fails to enter full-time
MPA
MPA
National Guard duty within 1 year of enlisting, I will be liable to the Board of Regents for all fees
Doctorate
Doctorate
waived by the university or college. I understand I must repay immediately any fees to which I am
liable at the time I become ineligible for the program. Failure to repay this debt shall result in the
Professional
Professional
withholding of my transcript record and denial of registration until such time as this debt is paid in
full.
Certification
Certification
Major:
Major:
Member's Signature
Date
CASHIER'S USE ONLY:
Grad Date:
Projected Grad Date:
Amount Waived $_____________
This semester?
PART C -- COMMANDER'S CERTIFICATION
8. I hereby certify that this individual is currently a member in good standing, IAW AR 600-200 or ANGI 36-2001, and I
will notify the Nevada National Guard Education Office of any changes in this individual's status.
PRINT: Cmdr/Designated Rep Name & Rank
Cmdr/Designated Rep Signature and Date
NEVADA NATIONAL GUARD EDUCATION OFFICER SECTION
CONTROL NUMBER: ____________________
Telephone Number: (775) 887-7326
Fax Number: (775) 887-7258/7279
Fax Number: (775)887-7279
Air Guard: (775) 788-4543
Air Fax: (775) 788-4542
NVMD Form 37W R4, July 2005
Previous Editions are obsolete
Privacy Act Statement on Reverse
Nevada National Guard
NEVADA NATIONAL GUARD
Education Officer
STATE EDUCATIONAL ENCOURAGEMENT FUND
2460 Fairview Drive
REQUEST FOR FEE WAIVER
Carson City, NV 89701-6807
(See Reverse for Instructions)
(775) 887-7258/7279
FAX: (775) 887-7279
PART A -- PERSONAL INFORMATION
1a. Name (Last, First, MI)
1b. Rank 1c. SSN
1d. Unit
1e. ETS Date:
1f. Affiliation (circle one) :
Army
Air
1g. Status (circle one ):
Technician
AGR
Traditional
2a. Mailing Address
2b. Home Phone:
Street or Box
2c. Work Phone:
City, State, Zip
2d. Cell Phone:
PART B -- EDUCATION INFORMATION
3. Degrees Held
4. Degree Sought
5.
UCCSN Institution (circle one ):
NONE
NONE
AA
AA
UNR
UNLV
NSC
TMCC
WNCC
CCSN
GBC
AS
AS
6.
Total Credit Hours Enrolled ___________________________
BA
BA
Term (circle one) :
Fall
Spring
BS
BS
Year ____________
MA
MA
7.
I have been counseled by my unit commander relative to the reasons for termination of my
MS
MS
eligibility under the Nevada National Guard Education Program and understand that I must
remain a member of the Nevada National Guard in good standing throughout the semester
MBA
MBA
attending and achieve at least a 2.0 GPA for the semester or I will be held liable to the Board of
Regents for all fees waived by the university or college. If I am a recruit who fails to enter full-time
MPA
MPA
National Guard duty within 1 year of enlisting, I will be liable to the Board of Regents for all fees
Doctorate
Doctorate
waived by the university or college. I understand I must repay immediately any fees to which I am
liable at the time I become ineligible for the program. Failure to repay this debt shall result in the
Professional
Professional
withholding of my transcript record and denial of registration until such time as this debt is paid in
full.
Certification
Certification
Major:
Major:
Member's Signature
Date
CASHIER'S USE ONLY:
Grad Date:
Projected Grad Date:
Amount Waived $_____________
This semester?
PART C -- COMMANDER'S CERTIFICATION
8. I hereby certify that this individual is currently a member in good standing, IAW AR 600-200 or ANGI 36-2001, and I
will notify the Nevada National Guard Education Office of any changes in this individual's status.
PRINT: Cmdr/Designated Rep Name & Rank
Cmdr/Designated Rep Signature and Date
NEVADA NATIONAL GUARD EDUCATION OFFICER SECTION
CONTROL NUMBER: ____________________
Telephone Number: (775) 887-7326
Fax Number: (775) 887-7258/7279
Fax Number: (775)887-7279
Air Guard: (775) 788-4543
Air Fax: (775) 788-4542
NVMD Form 37W R4, July 2005
Previous Editions are obsolete
Privacy Act Statement on Reverse
NVMD Form 37W R4, July 2005
Previous Editions are obsolete
Privacy Act Statement on Reverse
PRIVACY ACT STATEMENT
Authority: Section 510 and 511, Title 10, USC and Sections 301 & 304, Title 32, USC
Purpose: Provides information on service member requesting tuition benefits in the form of a fee waiver from the State of
Nevada.
Use: Serves as an information record confirming data for consideration of participation in tuition and lab fee waiver
program.
Disclosure: Disclosure of Social Security Number is voluntary, as is this program. Without SSN, member is not qualified
for tuition reimbursement consideration.
BOARD OF REGENTS' HANDBOOK
TITLE 4, CHAPTER 17, SECTION 13, SUBSECTION 4
4. Any member of the active Nevada National Guard, including a Nevada National Guard recruit, may be permitted to
register for credit without a registration fee or, except as otherwise provided, laboratory fee(s).
a. This policy is applicable during Fall and Spring terms only.
b. Independent study and correspondence courses are not eligible for waiver under this policy.
c. Laboratory fees associated with all courses numbered below the 300 level are eligible for waiver under this policy.
Exceptions to the waiver of laboratory fees includes: 1) per semester fees, such as the Health Service fee, 2) special course
fees for purposes other than class supplies – including individual instruction, third-party charges, and special
transportation requirements, 3) fees for actual class cost in excess of $100, and 4) technology fees.
d. A person to whom the fee waiver is awarded shall be deemed a bona fide resident of Nevada for tuition purposes.
e. To be eligible for the fee waiver, the person must be a member in good standing or a recruit of the active Nevada
National Guard at the beginning of and throughout the entire semester for which the waiver is granted.
f. The member or recruit of the Nevada National Guard must achieve at least a minimum 2.00 semester grade point
average in order to maintain subsequent eligibility for the fee waiver.
g. The institution may request the Adjutant General to verify the membership in the active Nevada National Guard of a
person who is seeking or has been granted the fee waiver.
h. If a fee waiver is granted to a Nevada National Guard recruit and the recruit does not enter full-time National Guard
duty within one year after enlisting, the student shall reimburse the Board of Regents for all previously waived registration
fees and laboratory fees, if the failure to enter full-time National Guard duty is attributable to the recruit’s own conduct.
i. If a fee waiver is granted to a member of the Nevada National Guard and the member does not achieve at least a
minimum 2.00 semester grade point average and remain a member in good standing with the Guard, the student shall
reimburse the Board of Regents for the semester’s waived registration fees and laboratory fees and will not be allowed to
register for additional courses until the debt is paid in full.
j. Registration fees associated with the William S. Boyd School of Law, the University of Nevada School of Medicine, and
the UNLV School of Dental Medicine are not eligible for waiver under this policy.
k. The Nevada National Guard fee waiver is effective as of Fall Semester 2003.
INSTRUCTIONS FOR NEVADA NATIONAL GUARD MEMBERS
1. This program is only for institutions of the Nevada System of Higher Education (NSHE).
2. Complete the NVMD Form 37WR3 and have your commander or designated unit representative sign it.
3. Fax the completed and signed form to the Nevada Army National Guard Education Officer at (775)887-7258.
4. The Nevada National Guard Education Officer will issue a control number to your unit commander or designated
representative and they will write it on your form.
5. You must fill out a separate NVMD 37WR3 and receive a separate control number for each school attending each
semester.
6. This is not a reimbursement program. You must submit this form to the Cashier's/Bursar's Office of the
institution to which you are enrolled at the time you pay your tuition and fees. A portion of the fees under the
program guidelines will be waived. You are responsible for paying any fees not waived under the program.
7. Forms must be submitted to the Cashier's/Bursar's Office on or before the respective deadline for paying fees
established at the NSHE institution you will be attending.
8. See the Board of Regents' policy concerning criteria for maintaining eligibility (Title 4, Chapter 17, Section 13,
Subsection 4(h) and 4(i)).
NVMD Form 37W R4, July 2005
Previous Editions are obsolete
Privacy Act Statement on Reverse

Download Form 37W R4 Request for Fee Waiver - Carson City, Nevada

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