Additional Educational Assistance Statement - education

PUBLIC SAFETY OFFICERS’ EDUCATIONAL ASSISTANCE (PSOEA) PROGRAM ADDITIONAL EDUCATIONAL ASSISTANCE STATEMENT AND STUDENT LOAN STATUS VERIFICATION ** PLEASE NOTE THAT YOUR PSOEA BENEFIT MUST BE REDUCED BY ANY OTHER GOVERNMENTAL OR PUBLIC SCHOOL ASSISTANCE YOU ARE ENTITLED TO RECEIVE, WHETHER YOU ACTUALLY APPLY FOR IT OR NOT. THEREFORE, YOU MUST CHECK WHETHER YOU ARE ELIGIBLE TO RECEIVE ASSISTANCE SUCH AS FEDERAL PELL GRANTS OR STATE TUITION WAIVERS BEFORE APPLYING FOR PSOEA BENEFITS. ** Please check one of the following and complete the requested information. SIGN AND DATE WHERE INDICATED AND FAX ALL THREE PAGES to your PSOEA contact with any other appropriate documentation: (Note that “educational assistance” refers to all public/government and private scholarships, grants and tuition waivers but not loans.) I am requesting benefits through the PSOEA Program for classes I am taking or have taken. For the period for which I am applying (for example, the Spring 2008 and/or Summer 2008 semesters), I have not received or applied to receive any other public/government or private educational assistance. In addition, I have determined that there are no other sources from which I am eligible to receive educational benefits. I am requesting benefits through the PSOEA Program for classes I am taking or have taken. For the period for which I am applying (for example, the Spring 2008 and/or Summer 2008 semesters), I have also received or have applied to receive educational assistance from public/government or private sources other than the PSOEA Program. Besides these, I have determined that there are no other sources from which I am eligible to receive educational benefits. I am requesting benefits through the PSOEA Program for classes I am taking or have taken. For the period for which I am applying (for example, the Spring 2008 and/or Summer 2008 semesters), I have also received or have applied to receive educational assistance from public/government or private sources other than the PSOEA Program. In addition, I have determined that there are other sources from which I am eligible to receive educational benefits, but I have not applied for them. Source of Assistance For the Period Amount Received, Applied For, or Entitled To But Did Not Apply For (** YOU MUST PROVIDE DOCUMENTATION, SUCH AS AN AWARD LETTER, SCHOOL BILL, OR FINANCIAL AID STATEMENT, SHOWING THE SOURCE AND AMOUNT OF ALL PUBLIC/GOVERNMENT AND PRIVATE EDUCATIONAL ASSISTANCE **) EXAMPLES Pell Grant Spring 2008 $1,000 Received _____________________________________________________________________ Tuition Waiver through State of Virginia Spring 2008 $1,920 Received _________________________________________________________________________________ Pell Grant Summer 2008 $1,000 Entitled to But Did Not Apply For _________________________________________________________________________________ Concerns of Police Survivors Summer 2008 $1,500 Received _______________________________________________________________________________ YOUR INFORMATION____________________________________________________________________________________ ____________________________________________________________________________________ ____________________________________________________________________________________ ____________________________________________________________________________________ _________________________________ _________________________________ ________________________ YOUR PRINTED NAME YOUR SIGNATURE DATE STUDENT LOAN STATUS VERIFICATION SECTION 32.38(a)(4) OF THE PSOEA REGULATIONS STATES THAT AN INDIVIDUAL WHO IS IN DEFAULT ON ANY STUDENT LOAN OBTAINED THROUGH TITLE IV OF THE HIGHER EDUCATION ACT OF 1965 WILL NOT RECEIVE PSOEA BENEFITS UNLESS THOSE BENEFITS ARE USED FOR REPAYMENT OF THE DEFAULTED LOANS AND THE STUDENT PROVIDES EVIDENCE OF THIS IN THE FORM OF AN APPROVED REPAYMENT PLAN. [ ] I have not obtained any student loans (such as Stafford Loans) through Title IV of the Higher Education Act of 1965. [ ] I have obtained students loans (such as Stafford Loans) through Title IV of the Higher Education Act of 1965 but am not in default on any of them. [ ] I am currently in default on loans (such as Stafford Loans) obtained through Title IV of the Higher Education Act of 1965. Assistance under the PSOEA Program is to be used for repayment of the defaulted loans and I am submitting an approved repayment plan with this form. [ ] I am currently in default on loans (such as Stafford Loans) obtained through Title IV of the Higher Education Act of 1965. I do not have an approved repayment plan. ____________________________________ YOUR PRINTED NAME ____________________________________ YOUR SIGNATURE _________________ DATE