Request V.A. Education Benefits Certification
In order to be certified for Education Benefits at North Shore Community College, please take a couple minutes to fill out this request form. This will provide us with accurate information, and allow us to be more proficient in our certifying.

Please fill out this form after registering for classes EVERY semester. We cannot certify you until you register for courses.

First Name *
Your answer
Last Name *
Your answer
Date of Birth (DAY-MON-YEAR) *
example: 15FEB1982
Your answer
Phone # (123-456-7890) *
Your answer
Email *
Your answer
Have you submitted proper documentation to receive qualified benefits? *
(DD-214, NOBE, VONAPP application, Certificate of Eligibility, etc)
Which semester are you wanting to be certified for? *
Required
What Educational Benefit are you planning to use? *
How many credits are you taking and what location
Please check each campus you are taking classes and list the number of credits
Number of Credits
Your answer
Number of Credits
Your answer
Number of Credits
Your answer
Number of Credits
Your answer
Are you taking an Internship or clinical? *
Required
Name & email of Internship/Clinical Coordinator
Your answer
Where is your internship or clinical location?
Your answer
**POST 911/CHAP. 33 ONLY **Do you need NSCC Health Insurance to be included in certification for benefits? *
It is required by law that students must have health insurance if registered for 9 or more credits. If you are enrolled in VA Healthcare or have your own private health insurance, then you don't need the school health insurance so check no and be sure to log in to PIPELINE and WAIVE the school Health Insurance
Have you applied for FAFSA? (Financial Aid) *
If you haven't yet applied, it is a free application: www.fafsa.ed.gov is the website to apply. 002173 is NSCC's School Code. Many Veterans are entitled to Pell Grants. Be sure to apply!!
Have you been certified at NSCC before? *
If not, the following documents are required to be turned in to Veterans Services before you can be certified: 1. DD-214 2. Certificate of Eligibility from V.A. or VONAPP Application
Required
What is your program of study? *
Your answer
Additional Comments or Questions
You can use this space, if you have particular questions about your certification or if you need to leave a special instruction for your certification.
Your answer
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