ARMY NATIONAL GUARD FEDERAL TUITION ASSISTANCE PROGRAM APPLICATION INFORMATION

See https://www.NationalGuardBenefits.com for eligibility. Availability of this program is based on federal funding.

1. Soldier Data
A. Name (Last, First, MI, Rank) B. SSN

STRYKER, KYLE, SGT

F. Home Address

256650283

C. MOS

D. ETS/MRD

E. BPED

25S
H. Degree Plan

20120620 20060621

G. Unit ID Code/State

1903 ABERCOMBIE RD

GULF BREEZE
2. School Name and Address

FL

32563

QFYB0

FL

Bachelors

PENSACOLA JUNIOR COLLEGE

1000 College Blvd Pensacola
3. Course Data
A. Course Code B. Course Title C. Delivery Mode D. Number of Credit Hrs E. Cost per Credit Hr F. Course Cost G. Authorized Fees H. Federal TA (estimate)

FL

32504-8998

ART1201
OST1100

TWO DIMEN DESIGN

Classroom

3 (SH)
3 (SH)
3 (SH)

$94.95

$284.85

$0.00

$284.85

KEYBOARDING I

Classroom
Classroom

$94.95
$94.95
$94.95

$284.85
$284.85
$284.85

$0.00
$0.00
$0.00

$284.85
$284.85
$284.85

STA2023
CGS1570

ELEM STATISTICS
COMP CONCEP APPLIC

Classroom

3 (SH)

TOTALS I. Course Begin Date J. Course End Date

$1,139.40

$0.00

$1,139.40

K. Cap Amount Applied

20110627
4. Soldier's Comments

20110808

$250.00 (SH)

I have sent the recoupment money for my one class from last semester. Please continue to submit this application.

5. Soldier's Review
Soldier has reviewed the ARNG Federal TA Application and certified that it is complete and accurate. Soldier consents to the release of financial information pertaining to his or her student account and the release of grades and/or course completion certification at the institution indicated above to the State ARNG Education Services Office processing tuition payments for this application. Soldier understands that if grades and/or completion certification from the above school are not submitted to the education office within 60 days of the originally scheduled course completion date, the soldier's account will be locked and ARNG Federal TA privileges will be suspended until all grades and/or completion certification is received and the State ARNG Education Services Office has updated the soldier's records. Soldier understands the requirement to reimburse the government for TA paid if he or she withdraws or does not complete a course except for reasons beyond the soldier's control, as determined by the State ARNG Education Services Office or the National Guard Bureau.

SUBMITTED ELECTRONICALLY BY SOLDIER ON: 6. Federal Tuition Assistance Manager

A. Name

Date

7/7/2011 9:42 AM

Chelsea Keith

B. Office Telephone

C. Email

904-827-8669

chelsea.keith@ng.army.mil