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Midland College Hazlewood Exemption (Hazlewood Act)
Application For Previous Exempt Recipients (HE-P)


Part A. Basic Eligibility:

Student ID #:
Social Security Number:
Student Full Name:
Student Date of Birth: format = MMDDYYYY
Street Address:
City:
State:
Home/Cell Phone Number: -
Email Address:


Term for which you are applying for the exemption:


Year: Hours:

Last term in which you used Hazlewood exemption:


Year:

Total of hours used: https://www1.thecb.state.tx.us/Apps/HSH/students
Are you currently default on any education loan, including those made or guaranteed by Texas:
(Note: THis will be verified by your institution)



Are you applying as a child spouse of a Texas service member?




Current State of Residency:
Military Service Number of Veteran (Social Security):
Full Name:
Date of Birth:
Zip Code:
   

Note: This application is for Hazlewood Recipients who previously qualified and used the benefits at MIDLAND COLLEGE and have a complete a Hazlewood Packet; New applicants should consult the Hazlewood Checklist for requirements.

Part B. Additional Information for Previous Exemption Recipients:


My name is and I am applying for an exemption from payment of tuition and certain fees under the Texas Education Code, Section 54.203 (Hazlewood Act). I understand that I may be entitled, under the law, to this exemption for up to 150 credit hours total at Texas public institution of higher education. For the purpose of accounting for the total number of hours for which I receive this exemption, I grant permission to any institution in which I have enrolled or will enroll to release current semester and historical credit hour information to the Texas Higher Education Coordinating Board and am granting permission for the Board to share such data with any institution that I might attends. I hereby certify the information I have provided is true and correct. I understand that if I fail to provide accurate information, I may be required to reimburse the institution and penalties may be imposed. (**Hours can ONLY be used by one Veteran//Child/Spouse at a time**)

I understand the statement above. Date:

NOTICE: I understand I must resubmit this application each semester to receive the Hazlewood Exemption.


Please select the button to the right to submit your information: