Member understands that in order to be eligible for Idaho State Education Assistance reimbursement I must meet the following membership criteria:

1. 6) ETS:
8) Phone:
IDNG SEAP Request Form v. 3 Dated 8 July 2015
PART E - STATE ACCOUNTING OFFICE
Amount: $ Date:
PCA: SUBJECT:
. PROJECT: Signature:
1. The Adjutant General may authorize the reimbursement of not more than $2500.00 for the consolidated tuition and registration fees for public or
private institution of higher education in Idaho, a vocational education school, or a community college organized under Title 33 chapter 21 of Idaho
Code for each State fiscal year per active drilling Idaho National Guard member until the exhaustion of the funds appropriated for this purpose.
2. To be eligible to receive benefits, a person must be a member in good standing, actively drilling, in the Idaho National Guard at the beginning of
and throughout the entire semester for which benefits are received.
3. The State of Idaho sponsors the State Education Assistance Program. The state legislature appropriates funds for this program annually. If, in
the future, the State does not fund the State Education Assistance Program, or funds are depleted, neither the State of Idaho nor the Idaho
National Guard are obligated to continue such a program or pay out existing obligations.
IDAHO NATIONAL GUARD STATE EDUCATION ASSISTANCE APPLICATION
PART A - PERSONAL INFORMATION
1) Print Name (Last, First, MI): 2) Rank: 3) Last 4 of SSN
4) Branch of Service: Army NG Air NG 5) Unit:
7) Mailing Address:
9) City, State, Zip: 10) Cell:
11) Email:
12) Unit of Assignment: 13) College/University: ADDRESS:
. PHONE: EMAIL:
14) Course(s) Submitted for Reimbursement: 15) Military Status: Traditional/M-Day AGR Technician
16) Term/Semester Start Date: End Date:
_______________________________________________________ _________________________
Member's Signature Date of Signature
PART C - UNIT CERTIFICATION
I hereby certify that this individual is currently a member in good standing and will notify the Idaho National Guard Education Office of any changes in this individual's
status.
17) Course(s) Block 14 Continued: 18) Total Amount of Reimbursement Requested:
PART B - STATEMENT OF UNDERSTANDING
I have read and understand the eligibility requirements as stated in the Idaho State Education Assistance Program Statement of
Understanding. I also understand that I must achieve a minimum Grade of "C" or above for requested course(s) or I will not be eligible to
receive reimbursement of tuition and registration fees. I understand that if this application is approved I must provide a copy of the course
grades within 30 days of course end date or or no later than 10 days prior to the end of the State fiscal year (30 June) and a completed W-9 in
order to be sent a reimbursement check.
_______________________________________________________ __________________________
Unit Representative/CSS Signature Unit Rep/CSS Signature Date
PART D - EDUCATION OFFICE CERTIFICAITON
Tuition Reimbursement Control Number: Date:
Education Representative Name:
Amount Paid to School: Education Rep.
Signature: