Request for Benefits - Summer 2017
Remember - Certification Level is Based on Unit Level and Class Length
8 Week Course - Full Time - 6 units
8 Week Courses - 3/4 Time - 4.5 units
8 Week Courses - 1/2 Time - 3.5 units

6 Week Courses - Full Time - 4 units
6 Week Courses - 3/4 Time - 3 units
6 Week Courses - 1/2 Time - 2.5 units

Last Name
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First Name
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Street Address
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City
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State
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Zip Code
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LBCC Student ID
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Phone
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Email Address
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Degree Objective(s)
Please select your Educational Goals - Check All that Apply
Required
Major
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2nd Major
Please indicate your secondary major/goal. The VA will only allow double majors when those majors are interrelated to a specific occupational career. Double majors/goals must be noted on your Educational Plan to be certified. (Certificate programs cannot be certified at this time.)
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What institution do you intend on transferring to?
Which GI Bill are you utilizing?
Are you requesting Advance Pay?
ONLY Chapter 30, 35, and 1606 are eligible for Advance Pay
Do you understand your responsibility to pay the student health fee and agree to pay it in a timely fashion (approx 3 days)?
Due to the lag of VA Payments, we recommend that all students pay their Student Health Fee within 3 days of enrollment. If a payment is not received in a timely fashion, LBCC has the right to drop students' courses.
Have you read and agree to adhere to the Standards of Student Conduct?
I certify that all information is complete and correct. I agree to inform the Veteran Services Office of any changes of enrollment. I understand that failure to do so may result in me owing a debt to the Veterans Administration. My initials will serve as signature and request to certify benefits.
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