Free Michigan 4363 Template in PDF
The Michigan 4363 form is an essential document for children of veterans seeking educational benefits through the Children of Veterans Tuition Grant Program. This program, established under Public Act 248 of 2005, aims to provide financial assistance to eligible applicants, helping them pursue their educational goals. Completing this application requires careful attention to detail, as it collects vital information such as the applicant's name, Social Security number, and contact details, alongside the specifics of their veteran parent or guardian. The form also inquires about the applicant's residency status and any existing benefits from other states, ensuring a comprehensive understanding of their eligibility. Additionally, it asks about any felony convictions, which may impact the application process. Required documentation includes the applicant's birth certificate, the veteran's discharge papers, and proof of disability or death due to service-related causes. The completed form, along with the necessary documents, must be submitted to the Student Scholarships and Grants office in Lansing, Michigan. By signing the application, the applicant affirms the accuracy of the information provided and authorizes the institution to verify academic data, thereby facilitating the processing of their request for educational benefits.
Form Example
Michigan Department of Treasury 4363
Application to Determine Eligibility for Educational Benefits
Children of Veterans Tuition Grant Program
Issued under authority of Public Act 248 of 2005.
Type or print all information. This application must be completed to apply for educational opportunities provided for children of certain members of the armed forces of the United States.
Name of Applicant |
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Social Security Number |
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Address (No., Street, P.O. Box or Rural Route) |
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City |
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State |
ZIP Code |
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Telephone Number |
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Date of Birth |
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Michigan Resident Since (mm/dd/yyyy) |
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Name of Surviving Parent or Guardian |
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Relationship |
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Address |
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Are you receiving benefits from another state? |
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Yes |
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No |
If Yes, what state? |
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Have you ever been convicted of a felony involving an assault, physical injury or death? |
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Yes |
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No |
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Name of College you plan to attend |
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College Enrollment Date (mm/dd/yyyy) |
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By my signature, I confirm that the information provided on this form is true and accurate, and I give the above institution permission to release/verify my academic data for the purposes of this program to the Student Scholarships and Grants. [Required for processing.]
Signature of Applicant |
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Deceased or Disabled Veteran’s Service Record (Parent of the Applicant named above)
Name of Veteran |
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Military Service Number |
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Date of Entry into Service |
Date of Separation |
U.S. Dept. of Veterans Affairs Claim No. |
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Veteran Affairs Regional Office where claim folder is located |
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Is the veteran totally and permanently disabled due to |
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Yes (see #4 below) |
No |
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Is the veteran’s death due to |
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Yes (see #4 below) |
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No |
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Required Documentation
Send photocopies only as documents must remain a permanent part of the application.
1.Applicant’s (child’s) birth certificate (must list parents’ names).
2.Veteran’s discharge certificate or separation document (DD Form 214 or Casualty Report)
3.Veteran’s death certificate or casualty report.
4.Proof of total and permanent disability or death due to
Submit application and required documentation to: Student Scholarships and Grants, P.O. Box 30462, Lansing,
MI
Document Specs
| Fact Name | Details |
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| Form Purpose | The Michigan 4363 form is used to apply for educational benefits under the Children of Veterans Tuition Grant Program. |
| Governing Law | This form is issued under the authority of Public Act 248 of 2005. |
| Eligibility Criteria | Applicants must be children of certain members of the armed forces of the United States. |
| Required Information | Applicants need to provide personal information, including their name, Social Security number, and address. |
| Documentation Needed | Photocopies of the applicant's birth certificate, veteran's discharge document, and proof of disability or death must be submitted. |
| Application Submission | Completed applications and required documents should be sent to Student Scholarships and Grants in Lansing, MI. |
| Contact Information | For assistance, applicants can call 1-888-4-GRANTS or fax their documents to 517-241-5835. |
| Signature Requirement | The applicant must sign the form, confirming the accuracy of the information provided. |
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