State of Georgia Post-Secondary Tuition Waiver Program Application

Name

First (required)

Middle

Last (required)

How did you learn about the Tuition Waiver Program (DFCS case manager, foster parent, group home staff, DFCS ILS, Google search, etc.)? (required)

Application Eligibility Type

I am a United States citizen or a permanent resident alien who meets the definition of an eligible noncitizen under federal Title IV requirements (select one):

Yes

No

I am currently enrolled full-time or part-time in a public postsecondary educational institution OR have been accepted for admission to a Technical College System of Georgia school/college (or program) within 3 years of obtaining a high school or GED diploma.

Yes

No

I am applying for the State of Georgia Post-Secondary Tuition Waiver under Georgia Code Sections 20-3-66 and 20-3-660 under the eligibility of (select one):

Foster Care Eligibility

Adoption Eligibility

In selecting the eligibility type above, I certify that I have carefully reviewed the eligibility criteria outlined in Code Section 20-3-66 and 20-3-660, along with the Certification and Affidavit found at the bottom of this application.

Student information

PREVIOUS NAME(S) (If applicable and known):

First

Middle

Last

AGE:

DATE OF BIRTH:

PHYSICAL ADDRESS

Country

Is your mailing address different from your physical address?

Yes

No

MAILING ADDRESS (if different from Physical Address):

Address

Address 2

City/Town

State/Province

ZIP/Postal Code

PHONE:

EMAIL (You will be contacted via email regarding your application):

Parent's Legal Name

I know my parent's legal name.

I do not know my parent's legal name.

(If Known) Parent's Legal Name

First

Middle Initial

Last

(If Known) Parent's Legal Name

First

Middle Initial

Last

Adoptive Parent's Legal Name

I know my adoptive parent's legal name.

I do not know my adoptive parent's legal name.

Not applicable, I do not have adoptive parents.

(If applicable) Adoptive Parent's Legal Name

First

Middle Initial

Last

(If applicable) Adoptive Parent's Legal Name

First

Middle Initial

Last

ELIGIBILITY INFORMATION

Have you ever been in foster care within Georgia?

Yes

No

First Year of Entrance into Foster Care in Georgia (if known):

Age at the Time of First Entrance into Foster Care in Georgia (if known):

County of Entrance into Foster Care (if known):

Please Note: This information will be verified by the State of Georgia Tuition Waiver participating agencies and institutions.

EDUCATION HISTORY

Are you currently seeking financial assistance in a state or federally funded dual-enrollment academic program?

Yes

No

Not sure

What is your highest level of education achievement?

High School Diploma

General Education Diploma (GED)

No High School Diploma or GED

Other…

Date Received or Anticipated Date of Completion: Month/Year

*POST-SECONDARY EDUCATION INSTITUTION INFORMATION

Please upload proof of enrollment or copy of acceptance letter

One file only.
256 MB limit.
Allowed types: jpg, png, pdf, zip.

Name of Institution:

Program Start Date: Month/Year

DEGREE TYPE SOUGHT (select one):

GED Testing Payment Request

Technical Certificate/Diploma

2-Year Associate Degree

ARE YOU SEEKING ON-CAMPUS HOUSING PROVIDED BY THE COLLEGE (select one):

Note: Only Central Georgia Technical College, North Georgia Technical College, and South Georgia Technical College are providing on-campus housing for students at this time.

Yes

No

You must currently be enrolled full-time or part-time in one of the listed Technical College System of Georgia schools/colleges (or program) below OR have been accepted for admission to a Technical College System of Georgia school/college (or program) within 3 years of receiving a high school or GED diploma.

Note: At this time, only schools within the Technical College System of Georgia are participating in the Tuition Waiver Program.

*CERTIFICATION STATEMENT AND AFFADAVIT

I have completed the Free Application for Federal Student Aid (FAFSA) PRIOR to completing this State of Georgia Post-Secondary Education Tuition Waiver application.

Yes

I understand that if my eligibility is approved, I will be unable to participate in the John H. Chafee Education and Training Voucher (ETV) program at the same time. The John H. Chafee Education and Training Voucher is for current or former youth and young adults who have experienced foster care. Additional information regarding Georgia’s ETV program can be found here: https://embarkgeorgia.org/etv.

Yes

The information I provided in this application and on this Certification and Affidavit are subject to penalties for withholding or providing false information, including but not limited to, criminal penalties for false swearing pursuant to O.C.G.A. §16-10-71 for program fraud. I certify, under penalty of perjury, that the information I have given is correct and complete to the best of my knowledge. I authorize the release of any information necessary to determine eligibility and service provision for the support or assistance I have requested.

Yes

Any person who intentionally makes or furnishes a false statement or misrepresentation on this application, or on any form or writing hereafter furnished for use in connection with this application, and any person who accepts or uses the same knowing it to be false, for the purpose of enabling the student to establish eligibility for, or to wrongfully receive, state student aid funds, may be subject to fine or imprisonment, or both, under provisions of Georgia law.

Yes

My eligibility determination based on my application will also be sent to the Technical College System of Georgia institutional representative.

Yes

*APPLICANT SIGNATURE

By signing electronically, I certify that the information given is correct and complete to the best of my knowledge.

State of Georgia Post-Secondary Tuition Waiver Program Application

Please upload proof of enrollment or copy of acceptance letter

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