Georgia Military Scholarship Verification of Status (VOS)

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Georgia Military Scholarship Verification of Status (VOS) To request a service cancellation for the Military Scholarship Cancelable Loan Program at the University of North Georgia or Georgia Military College. This VOS form should be completed and submitted to GSFA within 30 days of completing each year of service. Send completed form to: Georgia Student Finance Authority, 2082 East Exchange Place, Suite 240, Tucker, Georgia 30084 FAX 770.724.9209 or scan and email to [email protected] Part A: To be completed by Applicant 1. Last Name 2. First Name 3. Middle Name 4. Maiden Name 5. Social Security Number 6. Area Code and Phone Number 7. Permanent Mailing Address 8. City 9. State 10. Zip Code Part B: Statement of Repayment Information 11. Check the statement below that indicates your intention to repay your scholarship loan account. I plan to fulfill my obligation by serving _______ year(s) in the Georgia National Guard. Georgia National Guard Membership (check and complete one) Army National Guard Unit Air National Guard Unit After each year of duty, forward this form to your commanding officer to have Part C completed. Then send to GSFA. I plan to fulfill my obligation by serving ___________years(s) on active duty in the United States Army. Forward this form to your commanding officer to have Part C completed. If you have not reported for active duty, attach photocopy of orders attached to this form. Then send to GSFA. I do not plan to fulfill my obligation through service. Send me information regarding my cash repayment options. Return this form to GSFA without Part C or Part D completed. I am currently in school and not serving in the Georgia National Guard. I will fulfill my service obligation at the completion of my schooling. This choice is available for the Georgia Military College State Scholarship Loan only. Obtain enrollment verification from your school registrar and send to GSFA. ________________________________________________________ ______________________________________________________ 12. Signature of Applicant 13. Date of Signature Part C: Verification of Georgia National Guard Membership or United States Army To be completed by the recipient’s current Commanding Officer: Georgia National Guard 18. ________________________________________________ United States Army Title or Rank I certify that the above named individual has been a member in good standing in the Georgia National Guard or is serving on active duty in the United States 19. ________________________________________________ Army. Guard Unit 14. From: 15. To: 20. ________________________________________________ Give current date to indicate continuing service or discharge date if enlistment has terminated. Any breaks in service must be noted. Duty Station 16. _____________________________________________________ Signature of Commanding Officer 21. ________________________________________________ 17. _____________________________________________________ Signature Date Printed Name of Commanding Officer GSFA-4 (Rev. 05/2017) .

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Commission on the National Guard and Reserves 2521 S
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18 Lc 116 0030 Sr
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14 Lc 21 2531S
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