Veteran’s Enrollment Certificate This form must be completed & submitted every semester. You will not be certified to the VA until this form is received by the Veteran Services Office. Name* First MI Last Student ID Number*Address* Street Address City State / Province / Region ZIP / Postal Code If this is a new address, check here. This is a new address Phone*Email* Indicate Term and Year Fall Spring Summer Term YearProgram of Study*Branch of Service*New Students: Have you submitted an application for education benefits to the VA (Form 22-1990 for Chapters 33, 30, 1606 or Form 22-5490 for Chapter 35)?* No Yes Transfer Students: Have you submitted a Change of Program or Place of Training form to the VA (Form 22-1995 for Chapters 33, 30, 1606 or Form 22-5495 for Chapter 35)?* No Yes Submit a copy of your Certificate of Eligibility or NOBE to the Office of Veteran Services.Accepted file types: pdf, jpg, gif, doc, Max. file size: 128 MB. Terms and ConditionsPlease initial in front of all statements indicating you have read and understand each statement.1.*1. I must be matriculated in a curriculum/program of study leading to a VA approved degree or certificate program, and have all prior training evaluated (including military training) by the end of my second semester of enrollment. Failure to have all prior credit evaluated and applied to my curriculum may result in termination of my VA education benefits. I understand I will not be certified nor be paid by the VA for classes previously completed with a grade of "D" or higher and prior credit applicable to my program of study.2.*2. I understand the need to ensure the courses that I enroll in are required in my program of study, and understand I must continue to make satisfactory academic progress toward graduation. 3.*3. I understand the VA will not pay benefits for any online developmental/remedial classes. Enrollment in developmental (remedial) courses will not be certified for VA payment unless a need is established by a placement test or the approval for enrollment in a developmental course has been documented. 4.*4. I understand grades of W, I, NA or XA may result in a reduced payment from the VA which could result in an overpayment. Courses for which an incomplete (I) grade is awarded must be completed by the end of the subsequent semester (excluding summer semester). I am responsible for ALL debts resulting from corrections, reductions or terminations of my enrollment even if the payment was submitted directly to the school on my behalf.5.*5. Courses which are scheduled to meet in sessions other than the standard 15-week semester may be paid at a different rate based upon the number of credits and actual length of the course.6.*6. I understand the VA will hold me solely responsible for any overpayment of my VA Education Benefits. Which VA Education Benefit are you using? Tuition Assistance and MyCAA ScholarshipProgram Recipients Chapter 33 - Post 9/11 GI Bill and FryScholarship Chapter 30 1606 - Montgomery GI BillRecipients Chapter 31 - Vocational Rehabilitation Chapter 35 - Survivors and DependantsAssistance Tuition Assistance and MyCAA Scholarship Program Recipients7.*7. I am responsible for all fees and books. We highly encourage everyone to apply for financial aid at . 8.*8. I need to submit a copy of the approval for all courses for which I am using tuition assistance to the Office of Veteran Services. 9.*9. I understand I cannot use Chapter 1606 in conjunction with my tuition assistance. Chapter 33 - Post 9/11 GI Bill10.*10. I understand that electing to receive Chapter 33 benefits, in lieu of other education benefits, is IRREVOCABLE. The start date I list on the application (effective date) for benefits is also irrevocable. 11.*11. I understand I must be enrolled more than half-time (at least 7 credits) to receive any Basic Housing Allowance (BHA). I must be enrolled in 12 or more credits and have at least one residential (on campus) course to receive the full BHA. BHA is prorated based on enrollment and term dates. If I am enrolled in all online classes, the BHA I will receive will be 50% of the national average. 12.*12. I understand that the book stipend is a set amount multiplied by the number of credits that I am taking, and not the actual cost of my books. The book stipend will not exceed $1,000 or the prorated amount for those with less than 100% eligibility per academic year (fall, spring, and summer semesters). This amount is determined by the VA. Additionally, the book stipend may not arrive prior to the start of classes. 13.*13. I understand I am responsible for any tuition and fees not covered by the VA. 14.*14. I must report any scholarships, tuition specific grants and/or tuition assistance to the Office of Veteran Services. We highly encourage everyone to apply for financial aid at . Chapter 30 & 1606 - Montgomery GI Bill Recipients15.*15. I understand I must verify my enrollment and attendance at the end of each month. This verification may be done either by using the Web Automated Verification of Enrollment (WAVE) system on the VA website ( ) or by using the automated telephone system at 1-877-823-2378 and follow the prompts as directed (your VA file number is your social security number).16.*16. I am responsible for all expenses including tuition, fees, and books. These are out of pocket expenses. These costs occur prior to any payments to the veteran from the Department of Veterans Affairs. We highly encourage everyone to apply for financial aid at .Chapters 31 – Vocational Rehabilitation Recipients17.*17. I understand I must meet with my Vocational Rehabilitation counselor regularly and submit my grades to my Vocational Rehabilitation Counselor. 18.*18. I will submit a 1905 prior to every semester.19.*19. I will be responsible for any unauthorized purchases made at the College bookstore.Chapter 35 - Survivors and Dependents Assistance Recipients20.*20: VA file and suffix numbers or letter (41=A):21.*21. I am responsible for all expenses including tuition, fees, and books. These are out of pocket expenses. These costs occur prior to any payments to the student from the Department of Veterans Affairs. We highly encourage everyone to apply for financial aid at.Student Certification:Consent* I agreeI hereby authorize ºÚÁϳԹÏÍø to notify the Veterans Administration of any changes in my enrollment status. I understand it is my responsibility to keep the Office of Veteran Services informed of any change(s) in my military status (recalled or ordered to active duty), address, enrollment status, academic plan, and any other changes that may affect my attendance or grades. I understand should I fail to observe ºÚÁϳԹÏÍø and VA policies or any of the guidelines stated above, I agree to hold ºÚÁϳԹÏÍø harmless to pay any dues or damage(s) for intentional or negligent failure on my part.Student Signature*
