Fall 2017 Request for Benefits
Last Name
Your answer
First Name
Your answer
Student ID#
Your answer
Phone Number
Your answer
Email Address
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Street Address
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City
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Zip Code
Your answer
Degree Objective
Required
Major
2nd Major
Your answer
Transfer School
Which Educational Benefit are you utilizing
Are you requesting advanced pay? (Only Ch 30 & 35)
Will you pay health health fee?
Have you read and agree to adhere to the Standard of Student Conduct?
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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