VA Benefit Request Form
This form must be submitted every semester to utilize your veteran education benefit(s) and for certification to be processed.  

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Student ID number: *
Last Name: *
First Name: *
Phone Number:  *
Program of Study: *
VA Benefit(s) requesting to use. Please check ALL that will be applied:   *
Required
Check the semester that VA benefits will be applied. 
If you are a Continuing Education (CE) student, please select CE and answer the next section.  
 *
Required
CE students: Please state which program you will be using your VA Benefits for AND the date you will start. 
For example: 
Massage Therapy - starting 9/6/2024
Check if you'll graduate this year and which semester
(if applicable)
 *
Required
By checking either " I AGREE" box below, you are acknowledging and agreeing to Vernon College VA Benefits Office to use the above information you have provided to certify you with the VA Department or TVC for Hazlewood for the usage of education benefit.

You may also DECLINE to use the selected benefit(s) with the knowledge that neither the VA department or TVC Hazlewood benefit will be applied to your Vernon College Statement of Account.
 *
Required
Please let us know if you have any questions or concerns about your VA benefits. 
VA Benefits - va@vernoncollege.edu
(940) 696-8752 ext 2249 or 2007
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