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It is the total responsibility of the student to provide correct information pertaining to their current enrollment, courses being dropped or added, changes in degree program, repeated courses, remedial courses and mailing address changes. Failure to provide this information may result in a delay or loss of VA benefits, misdirected funds and possible repayment to the VA.

*Required

*5. Gender:

[email protected]

*11. VA Chapter:
*14. Graduating this Semester?
*15. Affiliation:
*16. Changing Programs?

If you selected yes, please complete and turn in the following forms:

Veterans: VA Form 22-1995

Dependents: VA Form 22-5495

*17. Are you a service member or veteran of:
*18. First semester of college?
*19. First time using benefits?

To receive VA benefits, please provide your term information below. Summer will have multiple terms.

Example: 8 hours

List each course name and term year.

List each course name and term year.

VA REGULATIONS

Degree Plan: Students can only receive benefits for classes in their degree plan.

Certification: Students must fill out a Certification Request and contact a school certifying official every semester to request VA enrollment certification. Students must notify certifying official of any changes in their enrollment, withdrawal, or change of major.

Repeats: Students will not be paid benefits for courses already successfully completed. This includes courses taken before receiving VA benefits.


UNDERSTANDINGS

1. I have read and understand the above VA Regulations. I also understand that I can be charged with an over payment if I receive benefits for which I am not entitled.

2. I understand, it is my responsibility to keep the certifying official notified of any change in my enrollment status. I also understand that failure to do so could affect my VA benefits.

3. I understand, if I elect to withdraw from a class, I may be required to repay the VA for that class.

4. I understand, (if applicable) if I use bookstore credit to purchase books and/or materials while waiting for my benefits, it is REQUIRED to be paid back within 30 days of the starting term.

5. I understand, (if applicable) I'll be responsible for paying inclusive fees.

I understand that typing my full name in this box constitutes a legal signature confirming that I acknowledge and agree to the understandings and each of the VA regulations above.