ࡱ> 46123%` 0 bjbjNN d,,]@$33335Dn6????wVn\`uwwwwww$h 5#hRwV#h#h??8?k?k?k#h*??u?k#hu?k?k7 ?6 3MivϻP<D:ir:C":e4ibrc?kdelibibib5k ibibibD#h#h#h#h*|2D|2 NETPDTC 1560/3 Rev. (03/06) TUITION ASSISTANCE APPLICATION This APPLICATION is not a funding document. Instructions: Complete and submit Tuition Assistance (TA) Application form (pages 1 and 2) to Navy College Office / Marine Corps Education Services Center PRIOR to the start of the term. This TA Application Form may be submitted via email, fax or in person. If completing by hand, print clearly. PRIVACY ACT STATEMENT Under authority of 5 USC 301 personal data is requested. Your SSN will be used for identification. This information will be included in your Education Record retained by the Navy College Office (NCO) or Marine Corps Education Services Center. It will not be divulged without your written consent to anyone other than the U.S. Government and/or school personnel involved with TA. You are not required to provide this information; however, failure to do so will result in not being considered for TA. For Navy, paper and/or electronic copies of the signed TA Application are retained at the originating NCO for three years and then shredded or burned. For Marines, copies of the signed TA Application are retained at the originating Marine Corps Education Services Center and shall transfer with the Marine to each new duty station. Copies of TA Applications and/or Authorizations for officers are maintained in their official personnel record for two years following the end of the last TA funded course. All other records are maintained in electronic format within the Navy College Management and Information System (NCMIS) indefinitely. Student / Applicant Information (Instructions: Tab to move to next field. Shift-Tab to move back. To make an X in block (, click with mouse or press your spacebar.)   FORMTEXT      FORMTEXT     FORMTEXT      Social Security Number  FORMTEXT       Last Name  FORMTEXT       First Name MI  ( FORMTEXT    )  FORMTEXT      FORMTEXT       FORMTEXT       FORMTEXT      FORMTEXT       Daytime Telephone Comm EXT DSN INTERNATIONAL ( FORMTEXT    )  FORMTEXT      FORMTEXT       FORMTEXT       FORMTEXT      FORMTEXT       Fax Number Comm EXT DSN INTERNATIONAL  FORMTEXT       Email Address GI Bill Enrollment Status: (Select only one)  FORMCHECKBOX  1. Vietnam Era  FORMCHECKBOX  2. VEAP  FORMCHECKBOX  3. MGIB  FORMCHECKBOX  4. EATP  FORMCHECKBOX  5. REAP  FORMCHECKBOX  6. None  ( FORMTEXT    )  FORMTEXT      FORMTEXT       FORMTEXT       FORMTEXT      FORMTEXT       Years of Education:  FORMTEXT    Command Phone Comm EXT DSN INTERNATIONAL Command Name:  FORMTEXT CBIRF 3399 STRAUSS AVE SUITE 219  FORMTEXT 20420 Command Address:  FORMTEXT INDIAN HEAD MD 20640 UIC or MCC/RUCStudent / Degree Planning InformationImmediate Academic Goals #1 - #8: (Select only one):  FORMCHECKBOX  1. High School Diploma  FORMCHECKBOX  2. Vocational/Technical  FORMCHECKBOX  3. Associate  FORMCHECKBOX  4. Bachelors  FORMCHECKBOX  5. Masters  FORMCHECKBOX  6. Doctoral  FORMCHECKBOX  7. Professional (i.e., MD, JD, DDS, etc)  FORMCHECKBOX  8. Continuing Education (CEU/Certificate) (Navy Only)  Do you have a degree plan for the goal listed above?  FORMCHECKBOX  Yes  FORMCHECKBOX  No(Complete this section for Academic Goals #1 - #7 only) Anticipated Graduation Date:  FORMTEXT       FORMTEXT    (enter only if within 12 months)  (yyyy / mm) School Issuing Degree:  FORMTEXT       Have you applied for graduation?  FORMCHECKBOX  Yes  FORMCHECKBOX  No (Complete this section for Academic Goals #3 & #4 only) Do you have a SOCNAV/SOCMAR Agreement?  FORMCHECKBOX  Yes  FORMCHECKBOX  No If yes, SOCNAV/SOCMAR College:  FORMTEXT       Are you enrolled in a Navy College Program Distance Learning Partnership (NCPDLP) Degree Program?  FORMCHECKBOX  Yes  FORMCHECKBOX  No If yes, NCPDLP School:  FORMTEXT      Course Request Information: School Name:  FORMTEXT       Term Start Date:  FORMTEXT       FORMTEXT     FORMTEXT    Term End Date:  FORMTEXT       FORMTEXT     FORMTEXT    (yyyy / mm / dd) (yyyy / mm / dd)School Location: (not street address)  City:  FORMTEXT        State:  FORMTEXT    (2 Character - ex: FL) Country:  FORMTEXT      Use the following information to enter the correct codes in the Course Description Blocks Below: (CD): COURSE DESCRIPTION 1 = On-Base (any military base) 2 = Off-Base 3 = Distance Learning 4 = Credit by Examination 5 = Deployed (Marine Corps only)(CL): COURSE LEVEL H = High School E = Continuing Education/Certificate D = Developmental/Prep (Navy Only) V = Vocational/Technical L = Lower Level (Freshman/Sophomore) U = Upper Level (Junior/Senior) G = Graduate Level (PIM): PRIMARY INSTRUCTIONAL MODE C = CD ROM I = Instructor P = Paper Based T = TeleTraining V = Video Tape W = Web/Internet(CU): CREDIT UNIT HOURS/TYPE S = Semester Q = Quarter C = Clock K = Carnegie (High School) N = Continuing Education Units (Navy only) Course Description Blocks. List one course per line. COURSE Dept Number COURSE TITLE CD codes above CL codes above PIM codes above CU codes above # of Credit Hours Tuition Cost Per Credit Hour Course Fee Total Course Cost  FORMTEXT       FORMTEXT       FORMTEXT       FORMTEXT   FORMTEXT   FORMTEXT   FORMTEXT   FORMTEXT     FORMTEXT       FORMTEXT       =(ch*tuit)+(crs) \# "$#,##0.00;($#,##0.00)" $ 0.00 FORMTEXT       FORMTEXT       FORMTEXT       FORMTEXT   FORMTEXT   FORMTEXT   FORMTEXT   FORMTEXT     FORMTEXT       FORMTEXT       =(ch_1*tuit1)+(crs1) \# "$#,##0.00;($#,##0.00)" $ 0.00 FORMTEXT       FORMTEXT       FORMTEXT       FORMTEXT   FORMTEXT   FORMTEXT   FORMTEXT   FORMTEXT     FORMTEXT       FORMTEXT       =(ch_2*tuit2)+(crs2) \# "$#,##0.00;($#,##0.00)" $ 0.00 FORMTEXT       FORMTEXT       FORMTEXT       FORMTEXT   FORMTEXT   FORMTEXT   FORMTEXT   FORMTEXT     FORMTEXT       FORMTEXT       =(ch_3*tuit3)+(crs3) \# "$#,##0.00;($#,##0.00)" $ 0.00Term/Semester Fee: List fee other than course fee. (example: library fee) FORMTEXT      TOTAL of all courses and fees: =SUM(ABOVE) $0.00 SUM(((ch*tuit)+crs)+((ch_1*tuit1)+crs1)+((ch_2*tuit2)+crs2)+((ch_3*tuit3)+crs3))) \# "#,##0.00"  {=SUM(((ch*tuit)+(crs))+((ch_1*tuit1)+crs1))+((ch_2*tuit2)+(crs2))+((ch_3*tuit3)+(crs3))+tfee)} \# "#,##0.00"  COMMAND APPROVAL: For the Applicants Commanding Officer, Executive Officer, or Officer in Charge: The applicants present or anticipated Military duties will permit him/her to attend and complete the course(s) listed above.  Signature of Commanding Officer or By Direction  FORMTEXT    Printed Name and Rank of Commanding Officer or signing Officer Date:  FORMTEXT       FORMTEXT     FORMTEXT     (yyyy / mm / dd)  NETPDTC 1560/3 Rev. (03/06) TUITION ASSISTANCE APPLICATION AGREEMENT This TA Application is a request to my servicing Education Center for a TA Authorization Voucher providing federal funds for my education. A. I understand acceptance of TA obligates me to the following: APPLICATION OBLIGATION: To submit this TA Application request to my servicing Military Education Center PRIOR to the start of the term. Once my TA Application is approved, I will receive a TA Authorization Voucher. To personally mail, fax or deliver my TA Authorization Voucher to the school. To pay the remainder of tuition and course fees not covered on the TA Authorization Voucher to the school. To notify the Education Center if any changes to the information on this document occur. To notify the Education Center if I do not enroll in any or all course(s) on this form or if I cancel before the schools drop/add date. To reimburse, via money order or cashiers check payable to U.S. Treasury and mailed to NETPDTC*, tuition and fees paid on my behalf if I: voluntarily withdraw from a course after the drop/add date or full tuition refund date and receive a (W) grade. receive a failing (F) grade. fail to clear an incomplete (I) grade within 6 months of course completion date. To provide NETPDTC a letter from my Commanding Officer confirming withdrawal for military or emergency reasons. Reimbursement may be waived if I officially withdrew based on these circumstances and if I submit command verification to NETPDTC *N8115. To provide grades to NETPDTC*. It is my responsibility to ensure my grades are forwarded to NETPDTC* within 60 days of course completion (30 days for Marines). Failure to do so could result in a formal resolution/collection effort of my military pay.  Correspondence for: NOTE: All correspondence and payments to NETPDTC should include Grades a. Your full name d. Term dates involved Reimbursement of military TA b. Your social security number e. Course name/number Letters from Commanding Officer verifying involuntary course withdrawal c. Name of school f. TA Authorization Voucher number Address: *COMMANDING OFFICER Other NETPDTC Contacts: NAVY MARINE CORPS_________________________ NETPDTC TA ACCOUNTING N8115 E-MAIL ADDRESS: SFLY_ HYPERLINK "mailto:TA.Navy@navy.mil" TA.Navy@navy.mil SFLY_ HYPERLINK "mailto:TA.Marine@navy.mil" TA.Marine@navy.mil 6490 SAUFLEY FIELD ROAD TELEPHONE: DSN 922-1001 x2 x2 or Comm (850) 452-1001 x2 x2 DSN 922-1001 x2 x3 or Comm (850) 452-1001 x2 x3 PENSACOLA, FL 32509-5241 FAX NUMBER: DSN 922-1149 or Comm (850) 452-1149 DSN 922-1032 or Comm (850) 452-1032 OTHER TA OBLIGATIONS: I understand if I am eligible for Montgomery GI Bill (MGIB) educational benefits, I may supplement TA through the MGIB Top-Up program. I understand that I may not claim full MGIB benefits for the same courses on this TA Application, as that would constitute a duplication of benefits from the Department of Veteran Affairs. C.8Vl Z^}~ĮqbqbqVbVqG joh!CJ OJQJ^Jh!CJ OJQJ^Jh!5CJ OJQJ\^Jh!B*CJ OJQJ^Jphh!5CJOJQJ\^J h!CJ h!CJ OJQJ^J h!CJ h!CJ h!CJOJQJ^J h!CJh!h!OJQJ^J h!CJh!>*CJOJQJ^Jh!B*CJphh!B*phh!B*OJQJph2 ^ RP %$If]%gd"9q %$If]% ,$If],gd"9q ,$If], ,0],^0$$a$|]|$|]|a$ $|0]|^0a$       "$(*,.BDFNP˸zkUzk?z+jh!5CJOJQJU\^J+jzh!5CJOJQJU\^Jh!5CJOJQJ\^J0jh"9q5CJOJQJU\^JmHnHu+jh!5CJOJQJU\^Jh!5CJOJQJ\^J%jh!5CJOJQJU\^J h!5\ jh!5U\mHnHuh!CJ OJQJ^Jh!B*CJ OJQJ^JphPRNPTǴӞӔ~p_pKp@~h!>*OJQJ^J&jh"9qOJQJU^JmHnHu!jh!OJQJU^Jjh!OJQJU^J*jh!CJOJQJU^JmHnHuh!OJQJ^J*jh"9qCJOJQJU^JmHnHu%jnh!CJOJQJU^Jh!CJOJQJ^Jjh!CJOJQJU^Jh!h!OJQJ^Jh!5CJOJQJ\^JP 6 <$If^ $Ifgd%@ $If^ $If^gd"9q ,$If], $$Ifa$$If %P$If]%  (*,24<>RTV\^`bvxz侬q\qGq)jrh!CJOJQJU^JaJ)jh!CJOJQJU^JaJ.jh"9qCJOJQJU^JaJmHnHu)j~h!CJOJQJU^JaJh!CJOJQJ^JaJ#jh!CJOJQJU^JaJh!CJaJh!OJQJ^Jjh!CJUmHnHuh!h!CJOJQJ^JaJjh!UmHnHu$&(246ؖvaI@h!>*CJaJ.jh!CJOJQJU^JaJmHnHu)jh!CJOJQJU^JaJh!CJOJQJ^JaJ#jh!CJOJQJU^JaJ)jlh!CJOJQJU^JaJ.jh!CJOJQJU^JaJmHnHu)jh!CJOJQJU^JaJh!CJOJQJ^JaJ#jh!CJOJQJU^JaJh!CJaJ68dt ,.08:^ǵzǵezǵPz)jXh!CJOJQJU^JaJ)jh!CJOJQJU^JaJ.jh"9qCJOJQJU^JaJmHnHu)jxh!CJOJQJU^JaJh!CJOJQJ^JaJ#jh!CJOJQJU^JaJh!CJaJh!>*CJaJh!CJOJQJ^JaJh!CJaJ"jh!CJUaJmHnHu^`tvxu]H?h!>*CJaJ)jh!CJOJQJU^JaJ.jh!CJOJQJU^JaJmHnHu)jHh!CJOJQJU^JaJh!CJOJQJ^JaJ#jh!CJOJQJU^JaJh!CJaJ.jh!CJOJQJU^JaJmHnHu)jh!CJOJQJU^JaJh!CJOJQJ^JaJ#jh!CJOJQJU^JaJ 4~>@Ϳrf`RJ?Rh!5CJ\aJh!CJaJh!CJ OJQJ^JaJ h!CJh!CJOJQJ^J.jh%@CJOJQJU^JaJmHnHu)jTh!CJOJQJU^JaJh!CJOJQJ^JaJ#jh!CJOJQJU^JaJh!CJOJQJ^JaJh!CJ OJQJ^JaJh!>*CJ OJQJ^JaJh!CJOJQJ^JaJh!CJaJ>@B"X$If @BD`bdf "$ҽҵҠҵzeҵUjh!CJOJQJUaJ)j( h!CJOJQJU^JaJ/j h"9qh"9qCJOJQJU^JaJh!CJOJQJ^JaJ)j@ h!CJOJQJU^JaJh!CJaJ)jh!CJOJQJU^JaJh!CJOJQJ^JaJ#jh!CJOJQJU^JaJh!CJOJQJ^JaJ$@BDVXZvxz|ɻ|xqk_xQI9jh!CJOJQJUaJh!CJaJh!CJOJQJ^JaJh!5\mHnHu h!CJ h!5\h! h!CJh!CJOJQJ%j h!CJOJQJU^Jh!CJOJQJ^Jjh!CJOJQJU^Jh!CJOJQJ^JaJh!CJaJjh!CJOJQJUaJ%j h!CJOJQJUaJh!CJOJQJaJX`VVVPP$If ,$If],kd $$If4      O\ "0* 0      +-4s4axf4  $&(02HJ^`ѻѳ~fQf<)j,h!CJOJQJU^JaJ)j h!CJOJQJU^JaJ.jh"9qCJOJQJU^JaJmHnHu)j2 h!CJOJQJU^JaJh!CJOJQJ^JaJ#jh!CJOJQJU^JaJh!CJaJ*jh"9qCJOJQJUaJmHnHujh!CJOJQJUaJ%j h!CJOJQJUaJh!CJOJQJaJ`bjlxzVX~͚{eXPBh!CJOJQJ^JaJh!CJaJh!CJaJmHnHu*jh!CJOJQJUaJmHnHu%j&h!CJOJQJUaJh!CJOJQJaJjh!CJOJQJUaJ)jh!CJOJQJU^JaJh!CJOJQJ^JaJh!CJaJ.jh!CJOJQJU^JaJmHnHu#jh!CJOJQJU^JaJmruykcyUM;#jh!CJOJQJU^JaJh!CJaJh!CJOJQJ^JaJh!CJ aJh!CJOJQJ^JaJh!CJ OJQJ^JaJh!CJOJQJ^JaJh!CJaJ h!5\h!CJOJQJ^JaJ.jh"9qCJOJQJU^JaJmHnHu)jh!CJOJQJU^JaJh!CJOJQJ^JaJ#jh!CJOJQJU^JaJ"c]]]SES U$If^ $If^$Ifkd.$$If      \ "0*   0      +-4s4ax"#8˸˪|gT|C5h!CJEHOJQJaJ h!5CJOJQJ\^JaJ%h!CJOJQJ^JaJmHnHu)jh!CJOJQJU^JaJh!CJOJQJ^JaJ#jh!CJOJQJU^JaJh!CJOJQJ^JaJh!CJOJQJ^JaJ%h!CJOJQJ^JaJmHnHu#jh!CJOJQJU^JaJ)j\h!CJOJQJU^JaJh!CJOJQJ^JaJ"#]^mwq$If($If($IfxkdZ$$If      0"0*%0      +-4s4ax89CDE[\]^mn롓zpz\H9h!CJOJQJmHnHu&jh!CJOJQJUmHnHu'h!5CJOJQJ\^JmHnHuh!OJQJ^J h!5CJOJQJ\^JaJh!CJaJh!EHOJQJ^JaJh!CJEHOJQJaJ)h!CJEHOJQJ^JaJmHnHu-j7h!CJEHOJQJU^JaJh!CJEHOJQJ^JaJ'jh!CJEHOJQJU^JaJmntj ($Ifkd$$If      Fn!"0*i$"0      +-    4s4ax!Aa#%Zu %$If]%%$If]%^ ,$If],hkd$$If4      r0*+- 0      +-4s4axf4   !"0124@ABPQRS`abpqʹժʹժyʹժ_ժժH,jsh!CJOJQJUmHnHu2jh%@h%@CJOJQJUmHnHu2jh"9qh"9qCJOJQJUmHnHu,jh!CJOJQJUmHnHuh!CJOJQJmHnHu!h!CJOJQJ^JmHnHuh!CJmHnHu&jh!CJOJQJUmHnHu,jh!CJOJQJUmHnHuqrt"#ЂkЂ\Qh!CJ mHnHuh!OJQJ^JmHnHu,jh!CJOJQJUmHnHu!h!CJ OJQJ^JmHnHu,j_h!CJOJQJUmHnHu,jh!CJOJQJUmHnHuh!CJOJQJmHnHu!h!CJOJQJ^JmHnHuh!CJmHnHu&jh!CJOJQJUmHnHu#$%Z[\jklmpstɵԄjԄ^SB:h!CJaJ h!5CJ OJQJ\^JaJh!5CJ\aJh!OJQJ^JaJ2jh"9qh"9qCJOJQJUmHnHuh!CJmHnHu,jKh!CJOJQJUmHnHuh!CJOJQJmHnHu&jh!CJOJQJUmHnHuh!CJmHnHu!h!CJOJQJ^JmHnHuh!CJmHnHujh!CJUmHnHuZ[ ($If $If^$If$If %$If]%  (*,02@ҽ҈n\Nh!CJOJQJ^JaJ#jh!CJOJQJU^JaJ"jh!CJUaJmHnHuh!CJaJ)jh!CJOJQJU^JaJh!CJaJ.jh!CJOJQJU^JaJmHnHu)j7h!CJOJQJU^JaJh!CJOJQJ^JaJ#jh!CJOJQJU^JaJh!CJOJQJ^JaJ JNPlnprx~رwbwPBh!CJOJQJ^JaJ#jh!CJOJQJU^JaJ)jh!CJOJQJU^JaJ#jh!CJOJQJU^JaJh!CJOJQJ^JaJh!CJaJ"jh!CJUaJmHnHuh!>*CJOJQJ^JaJ.jh!CJOJQJU^JaJmHnHu#jh!CJOJQJU^JaJ)j/h!CJOJQJU^JaJ" $ p ǿǮǘ|gǿU=U/jh"9qh"9qCJOJQJU^JaJ#jh!CJOJQJU^JaJ)jh!CJOJQJU^JaJh!CJOJQJ^JaJh!CJOJQJ^JaJh!5CJ\aJh!CJmHnHu h!5CJOJQJ\^JaJh!CJaJh!CJOJQJ^JaJ#jh!CJOJQJU^JaJ/j-h"9qh"9qCJOJQJU^JaJ" $ J!L!v"qgaaaaaaaa$If ,$If],kd$$If4      F0*` `0      +-    4s4axf4 !"!$!8!:!>h!CJaJh!>*CJOJQJ^JaJh!>*CJOJQJ^JaJ.jh!CJOJQJU^JaJmHnHu)j~h!CJOJQJU^JaJh!CJOJQJ^JaJ#jh!CJOJQJU^JaJ"jh!CJUaJmHnHuh!CJaJh!CJ OJQJ^JaJ h!5CJOJQJ\^JaJh!CJaJh!CJOJQJ^JaJ""0"2"4"6"<"B"D"`"b"d"f"j"x""""""""""´ߜ´´|gO@h!>*CJOJQJ^JaJ.jh!CJOJQJU^JaJmHnHu)jh!CJOJQJU^JaJh!CJOJQJ^JaJ#jh!CJOJQJU^JaJ/j~h"9qh"9qCJOJQJU^JaJh!CJOJQJ^JaJh!CJaJ)jh!CJOJQJU^JaJh!CJOJQJ^JaJ#jh!CJOJQJU^JaJv""" #i] %$If]%kd~ $$If4      F0*      0      +-    4s4axf4$If"""# # ###(#6#8#L#N#P#Z#\#^#b###ǸukZuFu;h!>*OJQJ^J&jh"9qCJOJQJUmHnHu!j."h!CJOJQJUh!CJOJQJjh!CJOJQJU h!CJh!CJOJQJ^J*jh!CJOJQJU^JmHnHu h!CJ h!5\h!5CJOJQJ\^Jh!5CJOJQJ\^J0jh!5CJOJQJU\^JmHnHu h!5CJOJQJ\^JaJ # ##^#$%:&&'R'{{ullf$If $Ifgd"9q$If%$If]%^gd"9q%$If]%^ekd{!$$If      0*+-  0      +-4s4ax ####################$$$>$`$d$f$z${oi[Qh!OJQJ^Jjh!OJQJU^J h!CJh!CJOJQJ^J$j#h!OJQJU\^J$j6#h!OJQJU\^Jh!5CJOJQJ\^Jh!5OJQJ\^J)jh"9qOJQJU\^JmHnHu$j"h!OJQJU\^Jh!OJQJ\^Jjh!OJQJU\^Jz$|$~$$$$$$$$$$$$$$$$$$$$&%%%:&<&F&¶ଛ¶ଊ}}qYKh!CJOJQJ^JaJ.jh!CJOJQJU^JaJmHnHuh!OJQJ^JaJ h!CJ h!>*CJ!j"%h!OJQJU^J!j$h!OJQJU^Jh!OJQJ^Jh!CJOJQJ^Jh!OJQJ^J&jh"9qOJQJU^JmHnHujh!OJQJU^J!j*$h!OJQJU^JF&P&`&b&v&x&z&&&&&&&&&&&&&ʵ؝{u{iYM:Y%j$&h!CJOJQJU^Jh!CJOJQJ^Jjh!CJOJQJU^Jh!CJOJQJ^J h!CJh!CJOJQJ^J*jh!CJOJQJU^JmHnHu.jh"9qCJOJQJU^JaJmHnHu)j%h!CJOJQJU^JaJh!CJOJQJ^JaJ#jh!CJOJQJU^JaJh!CJOJQJ^JaJh!CJaJ&&&&& ''('*','@'B'D'N'P'R'T' ( (,(-(.(/(;(N(O(P(\(](_(`(r(s(((ȼڰȖ{ocYccccch!OJQJ^Jh!CJOJQJ^Jh!CJOJQJ^Jh!CJ OJQJ^Jh!5CJOJQJ\^J h!5\%j&h!CJOJQJU^Jh!CJOJQJ^J h!CJ h!CJh!CJOJQJ^J h!CJjh!CJOJQJU^J*jh"9qCJOJQJU^JmHnHu"R'T' (y%($If]%xkd4'$$If      00* \ 0      +-4s4ax ( (,(-(.(O(\(r((((((vll %$If]%%($If]%^$If$If($Ifekd'$$If      0*+-  0      +-4s4ax (((((((((((( ))))2)3)B)V)W)X)g)w)x))))))))))))))) * ***A*B*C*D*P*Q*\*]*f*g****մ h!5CJOJQJ\^JaJh!CJOJQJ^Jh!h!5CJ\h!CJOJQJ^Jh!CJOJQJ^Jh!5CJOJQJ\^J h!CJh!OJQJ^Jh!CJOJQJ^J7(()2)W)w)))))))) **-*B*C*P*\*f*** $$Ifa$ $($Ifa$$If %<$If]% %($If]% %$If]%************++++!+"+&+1+2+3+7+B+C+E+I+T+U+V+Z+e+f+g+w+|+ƽͮ{u{u{u{oah!CJ OJQJ^JaJ h!CJ h!CJ h!CJ OJQJ^Jh!5CJ OJQJ\^Jh!5CJ \h!5CJOJQJ\^Jh!5CJOJQJ\^Jh!5CJ\ h!5\h!5CJ\ h!CJh!CJ OJQJ^Jh!CJOJQJ^Jh!CJ OJQJ^J#****[Q ($Ifkd($$If      \V V0*Q    V    0      +-4s4ax$If*****+!+"+&+,+2+3+7+=+C+~ $$Ifa$$If ,$If],hkd)$$If4      0*+-  0      +-4s4axf4C+E+I+O+U+V+Z+`+f+g+o+w+}+~++++++++++($If,V$If],^V $($Ifa$ ,$If],$If $$Ifa$$If|+}+~++++++++++++++, , ,,,$,Ǵu_OCh!CJ OJQJ^Jjh!CJ OJQJU^J*jh"9qCJ OJQJU^JmHnHu%j/h!CJ OJQJU^Jh!CJ OJQJ^Jjh!CJ OJQJU^J h!5\h!5CJ\%h!5B*CJOJQJ\^Jph%h!5B*CJ OJQJ\^Jphh!5CJ \h!5CJ OJQJ\^J h!CJ h!CJ aJ++,6,^,~,,,,-*-R----.>.^.~.... /2////Ff>Ff6 ,$If],$IfFf,$,&,(,2,4,6,8,L,N,P,Z,\,^,`,t,v,x,z,|,~,,,,,,,,,,ܺܺܺxbOb%j1h!CJ OJQJU^J*jh"9qCJ OJQJU^JmHnHu%j1h!CJ OJQJU^Jh!CJ OJQJ^Jjh!CJ OJQJU^J%j0h!CJ OJQJU^Jh!CJ OJQJ^J*jh"9qCJ OJQJU^JmHnHujh!CJ OJQJU^J%j0h!CJ OJQJU^J,,,,,,,,,,,,,,,,,,------&-(-*-,-@-ܺܺܺܺܺxeUxxjh"9qCJ OJQJU^J%j3h!CJ OJQJU^Jh!CJ OJQJ^Jjh!CJ OJQJU^J%j*3h!CJ OJQJU^J%j2h!CJ OJQJU^Jh!CJ OJQJ^J*jh"9qCJ OJQJU^JmHnHujh!CJ OJQJU^J%j2h!CJ OJQJU^J@-B-D-N-P-R-T---------------.......,...0.ܺܺsܺܺ`ܺܺM%jb9h!CJ OJQJU^J%j8h!CJ OJQJU^J%jd8h!CJ OJQJU^J h!5\!h"9qCJ OJQJ^JmHnHuh!CJ OJQJ^Jjh!CJ OJQJU^Jh!CJ OJQJ^J*jh!CJ OJQJU^JmHnHujh!CJ OJQJU^J%j4h!CJ OJQJU^J0.:.<.>.@.T.V.X.Z.\.^.`.t.v.x.z.|.~...............ξvcP%jr;h!CJ OJQJU^J%j:h!CJ OJQJU^J%jb:h!CJ OJQJU^J*jh!CJ OJQJU^JmHnHu%j9h!CJ OJQJU^Jh!CJ OJQJ^Jjh!CJ OJQJU^Jh!CJ OJQJ^Jjh!CJ OJQJU^J*jh!CJ OJQJU^JmHnHu............// / / /"/$/./0/2/4/////////xgx` h!5\!h"9qCJ OJQJ^JmHnHuh!CJ OJQJ^Jjh!CJ OJQJU^J%j<h!CJ OJQJU^J%jl<h!CJ OJQJU^J*jh!CJ OJQJU^JmHnHu%j;h!CJ OJQJU^Jh!CJ OJQJ^Jjh!CJ OJQJU^J/////////////0000"0$0&0(0<0>0@0B0D0F0H0\0ܺܺܺܺܺxeOxx*jh!CJ OJQJU^JmHnHu%jBh!CJ OJQJU^Jh!CJ OJQJ^Jjh!CJ OJQJU^J%j:Bh!CJ OJQJU^J%jAh!CJ OJQJU^Jh!CJ OJQJ^J*jh!CJ OJQJU^JmHnHujh!CJ OJQJU^J%j4@4B4~44Ŷ{e_L<h!B* CJOJQJ^Jph%h!5B* CJOJQJ\^Jph h!CJ*jh!CJ OJQJU^JmHnHu%jRh!CJ OJQJU^Jh!CJ OJQJ^Jjh!CJ OJQJU^Jh!CJ OJQJ^Jh!5CJ OJQJ\^J h!CJ h!5\!h"9qCJ OJQJ^JmHnHuh!CJ OJQJ^Jjh!CJ OJQJU^J34>4@4B44*6I?? ,$If],kdrS$$If4      F&0*`      H    Y 0      +-    4s4axf4p  %<$If]% %($If]%444444n5r5(6)6*6+6-6.6677777'7u7v7x7y7ǴǥLJthbTB#jh!CJOJQJU^JaJh!CJOJQJ^JaJ h!CJh!CJOJQJ^J$jh!5CJU\mHnHuh!5CJ\h!5CJ\h!CJOJQJ^Jh!5CJOJQJ\^J%h!5B*CJOJQJ\^Jph h!5\$h"9qCJ OJQJ\^JmHnHuh!CJ OJQJ\^J"jh!CJ OJQJU\^J*6+6,6-6aTT $,$If],a$kdT$$If4      F&0*      H   Y 0      +-    4s4axf4p -6.667%$If]%hkdU$$If4      0*+- 0      +-4s4axf477777G7v7w77777{r{b%V($If]%^V $Ifgd+H$If %($If]% ,$If],hkd{V$$If4      b0*+- 0      +-4s4axf4 y7777777777777777778˸򠒌rjrXJ5X)jWh!CJOJQJU^JaJh!CJOJQJ^JaJ#jh!CJOJQJU^JaJh!CJaJh!CJOJQJ^JaJh!CJOJQJ^J h!CJh!CJOJQJ^JaJ.jh!CJOJQJU^JaJmHnHu%h!CJOJQJ^JaJmHnHu#jh!CJOJQJU^JaJ)j4Wh!CJOJQJU^JaJh!CJOJQJ^JaJ777x88888t9URR$kd2Y$$If4      F k0*   0      +-    4s4axf4 ,$If], %<$If]%$If88 8$8&8:8<8>8B8D8V8X8l8n8p8t8v8x8z8888899ևwqe_XL>h!B*CJOJQJphh!B*OJQJph h!5\ h!CJh!CJOJQJ^J h!CJjh!CJUmHnHuh!>*CJOJQJ^JaJ)jXh!CJOJQJU^JaJ)j*CJ\ h!CJ\h!5CJOJQJ\^Jh!CJOJQJ^J h!CJh!5CJ\ h!CJh!5>*CJ\h!CJ OJQJ^J h!CJh!5CJ\h!5CJ\ h!CJh!5>*CJ \h!>*CJOJQJ^Jh!>*CJOJQJ^Jh!B*CJph#t9v9F:::::;k;l;;;(<)<<<==== & F"$If$If^` $If^ & F%$If $If^$If$a$==>>>>}?~??@@@@@@A#AAIBBCCCCCCCCCD#D˻|rrl_O_h!5>*CJ OJQJ\^Jh!>*CJ OJQJ^J h!CJh!CJ mH sH h!5CJ \mH sH h!>*CJ mH sH  h!CJ h!5CJ \h!5>*CJ \ h!5CJ h!5CJ jh!CJUmHnHu h!5CJh!CJOJQJ^JaJ h!5CJ h!CJ h!5CJh!CJOJQJ^J=>/>>iK & F$Eƀh.IfK & F$Eƀh.IfK & F$Eƀh.If>>}?~?@@@]AIBCCCDF GGGG <$If` $If` $If^$If $If^$If $If^ & F"$If $If^#DDDD-EVE[E\EEEEEEEEEEEEFFFF^FhFFF5GNGlGGGϮϒnaWQ h!CJh!CJ mH sH h!0J>*CJ mH sH *jZh!B*CJ UmH phsH h!B*CJ mH phsH $jh!B*CJ UmH phsH h!0J>*CJ "j Zh!B*CJ Uphjh!B*CJ Uphh!B*CJ ph h!CJ h!CJ h!5CJ OJQJ\^Jh!CJ OJQJ^JGGG)I+IefmxyGIJKlѴѥѥя|reVGh!6CJOJQJ]^Jh!6CJOJQJ]^Jh!6OJQJ]^Jh!OJQJ^J$jh!5CJU\mHnHu*jh!CJOJQJU^JmHnHuh!5CJOJQJ\^Jh!CJOJQJ^JUh!5CJOJQJ\^Jh!CJOJQJ^Jh!5>*CJOJQJ\^J$jh!5CJU\mHnHuG)IefxyGKLKLWX$-DIfM $$-DIfM a$ $If^$If & F $ t<($If^` As a Navy member pursuing an undergraduate academic goal, I understand I should obtain a degree Plan or SOCNAV Agreement by the time I have 5 TA-funded courses completed. As a Marine member pursuing an academic goal, I understand I should obtain a degree Plan or SOCMAR Agreement by the time I have 12 TA-funded semester hours or equivalent completed. D. (For Navy ONLY) I am aware of the limitation of 12 Semester Hours (or the equivalent of 18 Quarter Hours, 180 Clock Hours or 18 Continuing Education Units) in effect for Navy Tuition Assistance. (For Marines ONLY) I am aware of the limitation of $4500 TA per fiscal year. I certify that my request for TA does not exceed this limit. E. I understand I am responsible for any overpayment of TA. I must also reimburse TA funds when there is a cancellation of TA and any non-reimbursable fee has been paid to the college. F. Upon completion of a certificate or degree earned from an academic institution with national or regional accreditation recognized by the U.S. Department of Education; I will request my college send an official transcript to the Navy College Center (NCC). (For Marines ONLY) Upon completion of a certificate or degree, I will request my college send an official transcript to my unit diary clerk to be updated in the Marine Corps Total Force System (MCTFS).  Complete this form, sign; then fax, mail or deliver to your nearest Military Education Office TO FIND YOUR NEAREST Navy or Marine EDUCATION CENTER: For Navy, go to web site:  HYPERLINK "https://www.navycollege.navy.mil/ncp/findnco.cfm" https://www.navycollege.navy.mil/ncp/findnco.cfm For Marine Corps, go to web site: http://www.usmc-mccs.org/education/locations.cfm  (For QUESTIONS on this TA Application, contact your Military Education Center for assistance.) Tuition Assistance is available under Federal Law 10 USC 2007. By my signature, I certify I have read, understand, and will comply with all of the governing voluntary education instructions and the provisions on this form. I understand I will pay all costs over and above the amount of tuition assistance authorized. ___________________________________  FORMCHECKBOX  Enlisted  FORMCHECKBOX  Officer  Applicant s Signature Check status Application Date:  FORMTEXT       FORMTEXT     FORMTEXT    (yyyy / mm / dd)  FORMTEXT      FORMTEXT       EAOS Date:  FORMTEXT       FORMTEXT     FORMTEXT     Printed Name Rank Branch of Service (yyyy / mm / dd) (ex: E-1, O-2) Commissioned Officers Only: By my signature above, I agree, in accordance with 10 USC 2007, to remain on active duty for two (2) continuous years following the end of the last TA fKLXq#&VWXYַxfVJ7$jh!5CJU\mHnHuh!CJOJQJ^Jh!B*CJOJQJ^Jph"h!>*B*CJOJQJ^Jphh!CJ OJQJ^J h!CJh!0JCJOJQJ^J%jO[h!CJOJQJU^Jh!CJOJQJ^Jjh!CJOJQJU^Jh!5CJOJQJ\^Jh!CJOJQJ^Jh!5CJOJQJ\^Jh!5CJOJQJ\^JXw,$c||||n d$If $If$If]kd"\$$Ifl&# +,0,64 la|$<$-DIfM a$ YöÉyaRCÉyh!5CJOJQJ\^Jh!5CJOJQJ\^J.j\h!5>*CJOJQJU\^Jh!5>*CJOJQJ\^J(jh!5>*CJOJQJU\^Jh!5CJ\h!5CJOJQJ\^Jh!>*CJOJQJ^Jh!5CJOJQJ\^Jh!5CJ\h!5CJ\h!>*CJOJQJ^Jh!6CJOJQJ]^J,.j,24HJLĻē{{{i\Gi(j]h!CJOJQJU\^Jh!CJOJQJ\^J"jh!CJOJQJU\^Jh!5CJ\h!5CJOJQJ\^J0jh!5CJOJQJU\^JmHnHuh!5CJOJQJ\^Jh!5CJ\h!5CJOJQJ\^J(jh!5>*CJOJQJU\^J.j.]h!5>*CJOJQJU\^JLTVprfhͽu`VJD h!CJh!CJOJQJ^Jh!5>*CJ\(j^h!CJOJQJU\^Jh!CJOJQJ\^J h!CJ*jh!CJOJQJU^JmHnHu%j$^h!CJOJQJU^Jh!CJOJQJ^Jjh!CJOJQJU^Jh!5CJ\"jh!CJOJQJU\^J-jh!CJOJQJU\^JmHnHu *,Z\pҽߦwa[OFh!5CJ\h!CJOJQJ^J h!CJ*jh!CJOJQJU^JmHnHu%j_h!CJOJQJU^Jh!CJOJQJ^Jjh!CJOJQJU^J-jh!CJOJQJU\^JmHnHu(j_h!CJOJQJU\^Jh!CJOJQJ\^J"jh!CJOJQJU\^Jh!5CJOJQJ\^J$&(*,ٹ٬ٹ٬s`G`G0jh!5CJOJQJU\^JmHnHu$jh!5CJU\mHnHuh!5CJOJQJ\^J(jah!CJOJQJU\^J(j`h!CJOJQJU\^Jh!CJOJQJ\^Jh!5CJ\-jh!CJOJQJU\^JmHnHu"jh!CJOJQJU\^J(j `h!CJOJQJU\^J,4LABbc     ~rbh!5B*CJOJQJphh!CJOJQJ^J h!CJU h!5CJh!5>*CJh!5CJ \h!5CJ \^Jh!5CJ\^Jh!5CJ\^Jh!5CJ\^J h!CJh!CJ^Jh!5CJOJQJ\^Jh!5CJ\h!5CJOJQJ\^Jc   $,],a$]kda$$IflZ  +,0,64 la| <$If $Ifunded course. This obligation runs concurrently with any remaining obligated service time. This agreement does not obligate the military service to retain me on active duty. If allowed to voluntarily resign before my two year obligation is served, I will repay the government a portion of TA expended on my behalf during my last two years of active duty in accordance with 10 USC 2005. Reimbursement of TA does not negate the obligation.2 0&P1h/ =!"#$%@ 0&P1h/ =!`"`#$% zDText1###xDText2##|DText3####DText4 UPPERCASEDText119 UPPERCASEzDText7###zDText8###|DText9####~DText85####|DText86###D Text92 #############pD###pD###rD####~DText87####|DText93###D Text94 #############xD"Text109tDeCheck1tDeCheck2tDCheck3tDeCheck4vDeCheck22tDeCheck5,$$If!vh5555#v#v#v#v:V 4O0      +-5555/  / / / / / 44s4axf4~DText113###|DText16###~DText17####~DText95####|DText96###D Text114 ###########zDText18##,$$If!vh5555#v#v#v#v:V 0      +-,5555/  / / / /  / 44s4axD(Text13 UPPERCASEvD Text12$$If!vh5%5#v%#v:V 0      +-,5%5/ / / 44s4axD(Text98 UPPERCASE$$If!vh5i$5"5#vi$#v"#v:V 0      +-,5i$5"5/ /  / / / / 44s4ax$$If!vh5+-#v+-:V 4r0      +-5+-/ /  /  44s4axf4tDeCheck6tDCheck7tDCheck8tDCheck9vDCheck10vDCheck11vDCheck12vDCheck13vDCheck14vDCheck15~DText19####zDText20##D2Text21 UPPERCASEvDeCheck16vDCheck17$$If!vh5 55#v #v#v:V 40      +-++5 55/ / 44s4axf4vDeCheck18vDCheck19D(Text115 UPPERCASEvDeCheck20vDCheck21D-Text116 UPPERCASE$$If!vh5 55#v #v#v:V 40      +-++5 55/ / /  44s4axf4$$If!vh5+-#v+-:V 0      +-5+-/  /  44s4axD<Text117 UPPERCASE~DText25####zDText26##zDText27##~DText28####zDText29##zDText30##DText31 UPPERCASEDText32 UPPERCASED Text89 UPPERCASE$$If!vh5 5\ #v #v\ :V 0      +-5 5\ /  44s4ax$$If!vh5+-#v+-:V 0      +-5+-/  /  44s4ax$$If!vh5Q 5 5V 5 #vQ #v #vV #v :V 0      +-5Q 5 5V 5 /  44s4ax$$If!vh5+-#v+-:V 40      +-5+-/  /  44s4axf4F$$If!v h55c55X5H5555 5 H#v#vc#v#vX#vH#v#v#v #v H:V 4 d0      +-55c55X5H555 5 H/  44s4axf4pdkdB*$$If4       HpX $&0*  c    X  H          H   d0      +-((((4s4axf4pdDText33 UPPERCASEvDText34D(Text91 UPPERCASExDText37#DText38 UPPERCASEDText39 UPPERCASEDText40 UPPERCASEnD@chDHtuit#,##0.00DHcrs#,##0.00}$$If!v h555c55X5H555 5 5 H#v#v#vc#v#vX#vH#v#v #v #v H:V 40      +-, 555c55X5H55 5 5 H/  44s4axf4Ikd4$$If4       HpX $&0*    c    X  H          H  0      +-,,,,4s4axf4DText45 UPPERCASEvDText46D(Text47 UPPERCASExDText49#DText50 UPPERCASEDText51 UPPERCASEDText52 UPPERCASErD@ch_1DHtuit1#,##0.00DHcrs1#,##0.00}$$If!v h555c55X5H555 5 5 H#v#v#vc#v#vX#vH#v#v #v #v H:V 40      +-, 555c55X5H55 5 5 H/  44s4axf4Ikdr=$$If4       HpX $&0*    c    X  H          H  0      +-,,,,4s4axf4DText57 UPPERCASEvDText58D(Text59 UPPERCASExDText61#DText62 UPPERCASEDText63 UPPERCASEDText64 UPPERCASErD@ch_2DHtuit2#,##0.00DHcrs2#,##0.00}$$If!v h555c55X5H555 5 5 H#v#v#vc#v#vX#vH#v#v #v #v H:V 40      +-, 555c55X5H55 5 5 H/  44s4axf4IkdJF$$If4       HpX $&0*    c    X  H          H  0      +-,,,,4s4axf4DText69 UPPERCASEvDText70D(Text71 UPPERCASExDText73#DText74 UPPERCASEDText75 UPPERCASEDText76 UPPERCASErD@ch_3DHtuit3#,##0.00DHcrs3#,##0.00}$$If!v h555c55X5H555 5 5 H#v#v#vc#v#vX#vH#v#v #v #v H:V 40      +-, 555c55X5H55 5 5 H/  44s4axf4Ikd"O$$If4       HpX $&0*    c    X  H          H  0      +-,,,,4s4axf4DHText90#,##0.00#$$If!vh555H#v#v#vH:V 4 Y 0      +-+555H/  /  /  /  44s4axf4p )$$If!vh555H#v#v#vH:V 4 Y 0      +-+,555H/  /  /  /  44s4axf4p $$If!vh5+-#v+-:V 40      +-5+-/  / 44s4axf4$$If!vh5+-#v+-:V 4b0      +-5+-/ /  44s4axf4D(Text118 UPPERCASE~DText82####zDText83##|DText112##$$If!vh555 #v#v#v :V 40      +-555 /  44s4axf4DyK yK 0mailto:TA.Navy@navy.milDyK yK 4mailto:TA.Marine@navy.milDyK yK bhttps://www.navycollege.navy.mil/ncp/findnco.cfm$$If|!vh5,#v,:V l&#0,65,/ 4a|vDCheck23vDeCheck24DText106####|DText107##|DText108##xDText101xDText102DText103####|DText104##|DText105##$$If|!vh5,#v,:V lZ 0,65,/ / 4a|L@L Normal$CJOJQJ^J_HaJmH sH tH N@N Heading 1$@&5CJOJQJ\^JaJN@N Heading 2$@&5CJOJQJ\^JaJV@V Heading 3$@&^5>*CJOJQJ\^JDA@D Default Paragraph FontVi@V  Table Normal :V 44 la (k(No List :O: Main Title >*CJ$\J>@J Title$<@&a$5CJ KH\aJ \C@\ Body Text Indent ^5CJOJQJ^JaJFQ@"F Body Text 3CJOJQJ^JaJ>B@2> Body TextCJOJQJ^J^P@B^ Body Text 25$7$8$9DH$`CJOJQJ^JaJ@ @R@ Footer  ! OJQJ^J6U@a6 Hyperlink >*B*phH@rH  Balloon TextCJOJQJ^JaJFV@F FollowedHyperlink >*B* phRYR  Document Map-D M OJQJ^J= ]@22^ @WXYmxy  $ 6 7 8 Y s 9 : t u 8Xx:<qrJaxyDpq}&M567Xe{";`$6KLYeo*+/5;<@FLNRX^_ciopx"2BRdx"2BTh|&6H\p *<Pd# *YZkm : ; < = !V!W!o!p!!:";"""""R#S###m$n$$$P%Q%L&M&`'a'e',())**+,-.../_1`122r3s3A5E5F555E6F666Q7R77779q9z9::w;~;<]==Z@[@_@0000000000000000000 000000000 000000000 00000000000 0 00 0 0 0 0000 000 00 0 0 00 000000000000000 0 000000 0 0 0 00000000 0 0 00000 0000 0 0 000000000 000000000 00000000 000000000 0 000000000000000000000000000000000000000 0 0 0 0 0 0 0 0 0 0 0 0000000000000000000000000000000000000000 000000000000000 00000 00000 0 000= 0= 0= 0= 0= 0= % 0= 0= 0= % 0= 0= % 0= 0= " 0= 0= " 0= 0= " 0= 0=  0=  0=  0= 0= " 0= 0= " 0= 0= 0= 0= 0= 0= 0= 0= 0= 0= 0= 0= 0= 0=  0$= 000000000000000000 0 000000000000 0 02BRdx_@00芖000 000000000芖0 00 P6^@$`8q# ""#z$F&&(*|+$,,@-0../\001n234y789=#DGYL, %()+,-./124568:=>?ABCEFHJKLMPRVXYZ[\]_`abceiklnqr}P"mZv" #R' ((**C++/3*6-677t9=>GXc &*0379;<@DGINOQSTUW^dfghjmops~ ' (+-9>Yeky ,05AEGSXlx}    " . 3 F R W _ k o y 8 H Y i s      * / ; G L S _ c i u {  O [ r 8HXhxr !yIYaq"*:\hn ;GLT`clx{9EK_kn  ".02>@BNPR^bdpvx ".02>@BNRT`fhtz|"$&246BFHTZ\hnp &(*6:<HNP\bd#178 [gi *,Q,b,,,,|6669999:::::::::;;;; <<:<F<K<X<d<g<v<<<]@FtFtFtFtFtFtFtFtFtFtFtFtFtFtFtFtFtFtG$G$G$G$G$G$FtFtFtFtFtFtFtFtFtFtG$G$G$G$G$G$G$G$G$G$FtFtFtG G$G$G$FtG$G$FtFtFtFtFtFtFtFtFtFtFtFtFtFtFtFtFtFtFtFtFt"4FtFtFtFtFtFtFtFtFtFt"4FtFtFtFtFtFtFtFtFtFt"4FtFtFtFtFtFtFtFtFtFt"4Ft"4FtFtFtFtXXXG$G$FtFtFtFtFtFtFtFt p0e0e     A5% 8c8c     ?1 d0u0@Ty2 NP'p<'pA)BCD|E||S"@# B(  "b  #  % #" TB & C D# # TB ' C D   HB @@ C DNB  S D>zB  < D?"tB  6 D?"tB  6 D?"zB  < DV?"zB @ < DV?"zB @ < DV?"zB  < DV?"tB  6 D?"tB  6 D?"tB  6 D?"tB  6 D?"tB  6 D?"tB  6 D?"tB  6 D?"tB  6 D?" tB  6 D?" tB  6 D?" tB  6 D?" tB  6 D?"tB  6 D?"tB  6 D?" zB  < D>?"zB  < D>?"tB  6 D?"tB  6 D?"tB  6 D?"tB  6 D?"zB  < D>?"zB  < D>?"B S  ?m:Jyq&Mk a'.A5B5C5R7:<<<<]@%Ot""t; ;t 00t@t}BBttttO0w 0to/t/ t@,tt0tXtq tYt t[Kt t+t+t+t+2+t?+?tb+bt,+t>u\utu@+ut~uut~uutuText1Text2Text3Text4Text119Text7Text8Text9Text85Text86Text92Text87Text93Text94Text109Check1Check2Check3Check4Check22Check5Text113Text16Text17Text95Text96Text114Text18Text13Text12Text98Check6Check7Check8Check9Check10Check11Check12Check13Check14Check15Text19Text20Text21Check16Check17Check18Check19Text115Check20Check21Text116Text117Text25Text26Text27Text28Text29Text30Text31Text32Text89Text33Text34Text91Text37Text38Text39Text40chtuitcrsText45Text46Text47Text49Text50Text51Text52ch_1tuit1crs1Text57Text58Text59Text61Text62Text63Text64ch_2tuit2crs2Text69Text70Text71Text73Text74Text75Text76ch_3tuit3crs3Text90Text118Text82Text83Text112Check23Check24Text106Text107Text108Text101Text102Text103Text104Text105 .Zz!6HmG ` z 9 Z t  < T j P 9YyszJb+]<Um:`#3CSey#3CUi'7I] +=Q\99:::;;;<Y<w<_@  !"#$%&'()*+,-./0123456789:;<=>?@ABCDEFGHIJKLMNOPQRSTUVWXYZ[\]^_`abcdefghijklmnopqrst,?l1FY~X p I j  0 M d |  s Ii"Zr#;o Md|Lo!1AQcw!1ASg{%5G[o );Ocj 99:::;<L<h<<_@DlEFGH|IJKLL\MdNO$PQLRS.TUV WX,Y4Zt[d\]̎M M MMT a#a#k#----,6,636=67777_@     T T SZZ j#q#q#--..26<6C6C67777_@   8 *urn:schemas-microsoft-com:office:smarttagsCity9 *urn:schemas-microsoft-com:office:smarttagsState> *urn:schemas-microsoft-com:office:smarttags PostalCode=*urn:schemas-microsoft-com:office:smarttags PlaceName=*urn:schemas-microsoft-com:office:smarttags PlaceTypeB*urn:schemas-microsoft-com:office:smarttagscountry-region9*urn:schemas-microsoft-com:office:smarttagsplace Ă   RV 6 8 )[***,,g-i-m-q-----K.O....;2;R;T;==8=:=_@4Zrg ~ ;"I"n$y$$$$%_@333333333 Yy s r : u 8xr$|pd#Zu= W!p!..&@\@_@_@%oUA n۰- $` ~x $ :lo[#榚t*ahCSA-\z#$d-k-N~V0O8TF1H_3,;':F. !b=֣x2'~BԖ5C dJ&7p|S։T&\xj_NEa6w]pe 'e:g2V9 hPuph{EKijX( RRvk$(qZb MWrh0D=?Js+` otb4(9vfd%'zNK{ )|R5 8^` o(.^`o(.$ $ ^$ `5o(.@ @ ^@ `.^`.L^`L.^`.^`.PLP^P`L.^`5o(.^`.pLp^p`L.@ @ ^@ `.^`.L^`L.^`.^`.PLP^P`L.xx^x`o(.HH^H`.L^`L.^`.^`.L^`L.X X ^X `.(#(#^(#`.%L%^%`L.PP^P`o(.  ^ `.L^`L.  ^ `.  ^ `.`L`^``L.00^0`.^`.L^`L.hhh^h`o(.h 88^8`OJQJo(oh ^`OJQJo(h   ^ `OJQJo(h   ^ `OJQJo(oh xx^x`OJQJo(h HH^H`OJQJo(h ^`OJQJo(oh ^`OJQJo(88^8`o(.^`. L ^ `L.  ^ `.xx^x`.HLH^H`L.^`.^`.L^`L.^`5o(.^`.pLp^p`L.@ @ ^@ `.^`.L^`L.^`.^`.PLP^P`L.88^8`o(.^`. L ^ `L.  ^ `.xx^x`.HLH^H`L.^`.^`.L^`L.88^8`o(.##^#`o(.^`.L^`L.  ^ `.c c ^c `.3L3^3`L.^`.^`.L^`L. 8^` o(.^`.pLp^p`L.@ @ ^@ `.^`.L^`L.^`.^`.PLP^P`L.^`o(.^`. L ^ `L.  ^ `.xx^x`.HLH^H`L.^`.^`.L^`L.88^8`o(.^`. L ^ `L.  ^ `.xx^x`.HLH^H`L.^`.^`.L^`L. TT^T`OJ QJ o(^`CJOJQJo(n ^`OJ QJ o(- QQ^Q`OJQJo( ^`OJQJo( ^`OJQJo( M M ^M `OJQJo(   ^ `OJQJo(   ^ `OJQJo(8^`o()^`.pLp^p`L.@ @ ^@ `.^`.L^`L.^`.^`.PLP^P`L.88^8`5o(.^`. L ^ `L.  ^ `.xx^x`.HLH^H`L.^`.^`.L^`L.PP^P`o(.^`.pLp^p`L.@ @ ^@ `.^`.L^`L.^`.^`.PLP^P`L.^`5o(.^`.pLp^p`L.@ @ ^@ `.^`.L^`L.^`.^`.PLP^P`L.##^#`o(.^`.pLp^p`L.@ @ ^@ `.^`.L^`L.^`.^`.PLP^P`L.P^`o(.^`.pLp^p`L.@ @ ^@ `.^`.L^`L.^`.^`.PLP^P`L.hhh^h`.h88^8`.hL^`L.h  ^ `.h  ^ `.hxLx^x`L.hHH^H`.h^`.hL^`L.p^`OJPJQJ^Jo( ^`OJQJo(o pp^p`OJQJo( @ @ ^@ `OJQJo( ^`OJQJo(o ^`OJQJo( ^`OJQJo( ^`OJQJo(o PP^P`OJQJo(PP^P`o(.  ^ `.L^`L.  ^ `.  ^ `.`L`^``L.00^0`.^`.L^`L.h ^`OJQJo(h ^`OJQJo(oh pp^p`OJQJo(h @ @ ^@ `OJQJo(h ^`OJQJo(oh ^`OJQJo(h ^`OJQJo(h ^`OJQJo(oh PP^P`OJQJo(hP^`o(.h@ @ ^@ `.hL^`L.h^`.h^`.hL^`L.hPP^P`.h  ^ `.hL^`L.88^8`o(.^`. L ^ `L.  ^ `.xx^x`.HLH^H`L.^`.^`.L^`L.PP^P`o(.^`.pLp^p`L.@ @ ^@ `.^`.L^`L.^`.^`.PLP^P`L.^`5o(.^`.pLp^p`L.@ @ ^@ `.^`.L^`L.^`.^`.PLP^P`L.hh^h`o(.^`.L^`L.  ^ `.U U ^U `.%L%^%`L.^`.^`.L^`L.hhh^h`.h88^8`.hL^`L.h  ^ `.h  ^ `.hxLx^x`L.hHH^H`.h^`.hL^`L.88^8`5o(.^`. L ^ `L.  ^ `.xx^x`.HLH^H`L.^`.^`.L^`L.0^`0o(.^`. L ^ `L.  ^ `.xx^x`.HLH^H`L.^`.^`.L^`L.88^8`o(.h^`5o(.h^`.hpLp^p`L.h@ @ ^@ `.h^`.hL^`L.h^`.h^`.hPLP^P`L.88^8`o(.^`. L ^ `L.  ^ `.xx^x`.HLH^H`L.^`.^`.L^`L.^`5o(.^`.pLp^p`L.@ @ ^@ `.^`.L^`L.^`.^`.PLP^P`L.88^8`o(.^`. L ^ `L.  ^ `.xx^x`.HLH^H`L.^`.^`.L^`L.%q=?Js$` SA-` ot%'z_3'e:gp|SF1~V0 )|t*MWr !b=9 hj_'::k-oUA $d-RRvk]pex $dJ&\Kij5CK{4(9v- o[#ph'~Ba%%'|;Ip               ]ȸ        |;                         L        |;        '        F(J        פ1                 >&X        ]ȸ        *        |;        sR                          ]ȸ                 2fn        Z[        ]ȸ        R        |;                         U                 ȶ           @ @ @B&+H"9q%@! 9 : t u pq$*;L^o"2BRdx"2BTh|&6H\p *<Pd# Y; < !77Z@[@_@""""""""""""">"6@ 99 990         /9:;<>]@@4@ "&P@,.04l@8t@@@@Unknowncarol.r.thompson Gz Times New Roman5Symbol3& z ArialABook Antiqua;Wingdings?5 z Courier New71 Courier;" Helvetica5& z!TahomaO9999999Courier New"q hSFSFiF 6 t 6 t:!`x24d=@=@S 2QHX)?B&2JC:\WINNT\Temporary Internet Files\OLK12\taform1560-3 revised 21 Apr 04.dotNETPDTC 1560/ TA ApplicationNCPlawrence.e.pieper%                           ! " # $ Oh+'0  <H h t   NETPDTC 1560/ TA ApplicationNCP taform1560-3 revised 21 Apr 04lawrence.e.pieper2Microsoft Office Word@F#@Mk@b鰻@b鰻 6Properties ?@ABCDEFGHIJKLMNOPQRSTUVWXYZ[\]^_`abcdefghijklmnopqrstuvwxyz{|}~      "#$%&'(+,-./0:58C9);>=?DE<Root Entry Fr7 Data (b1TableWordDocumentdSummaryInformation(!DocumentSummaryInformation8|CompObjqMsoDataStorerr ! "#$%&'()*+,-  FMicrosoft Office Word Document MSWordDocWord.Document.89q as.microsoft.com/office/2006/metadata/longProperties"/>MJPOUUU4BQ==2 rrItem  PropertiesYXHBG0ZSODOWQ==2 rrItem  Properties JPG4N2X4T1QQ==2rrItem *ernalDocumentation"> ref="ns1:PublishingStartDate" minOccurs="0"/> This value indicates the number of saves or revisions. The application is responsible for updating this value after each revision. xsd:schema> maxOccurs="1"/> This value indicates the number of saves or revisions. The application is responsible for updating this value after each revision. DocumentLibraryFormDocumentLibraryFormDocumentLibraryFormF61-C1E1-41EA-9A65-2A0E0E5DCE59}" xml w>ffice/2006/metadata/longProperties"/>