Summer 2016 - Request for Benefits
Last Name
Your answer
First Name
Your answer
Student ID#
Your answer
E-Mail
Your answer
Telephone #
Your answer
Have you created a file at the VSO?
When was the last term you were certified?
(This will help us figure out where your file is currently housed. Files are housed in three different locations.)
Major
Your answer
Second-Major
Your answer
Educational Goal
Required
Type of Benefit Utilized
REMEMBER: CERTIFICATION LEVEL IS DETERMINED BY UNITS & 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

Course Name & Number - Unit Level
Course Name & Number, and Number of Units. (Ex. COMM 10 - 3 units)
Your answer
Course Name & Number - Unit Level
Your answer
Course Name & Number - Unit Level
Your answer
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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