Fall 2016 Request for Benefits
Last Name
Your answer
First Name
Your answer
Student ID
Your answer
Street Address, City, State, Zip Code
Your answer
Phone Number
Your answer
Email
Your answer
When was the last term you were certified?
Major
Secondary Major
Your answer
Educational Goal
(Note: The CSAAVE will no longer approve certification of Certificate Programs)
Required
Transfer College
Type of VA Benefit Utilized
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.
Your answer
I understand all students must adhere to the Student Code of Conduct at all times while on the college campus.
Your answer
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.
Your answer
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