Fall 2016 Request for Benefits
Street Address, City, State, Zip Code
When was the last term you were certified?
Before Spring 2016
(Note: The CSAAVE will no longer approve certification of Certificate Programs)
Associates Degree/Associates Degree for Transfer
Transfer to CSU
Transfer to UC
Transfer to Private College
Type of VA Benefit Utilized
Chatper 30: Montgomery GI Bill
Chapter 31: Vocational Rehabilitation (We may need an updated 1905-check with the office)
Chapter 33: Post 9/11 GI Bill (Veterans)
Chapter 33: Transfer of Entitlement - Post 9/11 GI Bill (Dependents)
Chapter 33: Fry Scholarship - Post 9/11 GI Bill (Surviving Dependents)
Chapter 35: Dependents Educational Assistance Program (Dependents)
Are you requesting Advanced Pay?
Only Chapter 30 and Chapter 35 are eligible for Advance Pay
I understand that it is a student's responsibility to pay the health fee within 72 hours after registration. I also understand that while the VA may pay my fees, that the lag between drop period and payment may cause the enrollment system to automatically drop me for non-payment. Subsequently, paying the health fee will ensure my courses are held.
I understand all students must adhere to the Student Code of Conduct at all times while on the college campus.
I certify that all information is complete and correct. I agree to inform The Veterans Service Office of any changes in my enrollment status (adding/dropping certified class). I understand that failure to do so may result in me owing a debt to the Veterans Administration.
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