Va G.i. Bill Enrollment Form - Lincoln Land Community College
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2Questions about how to
Return completed form to:
complete this form?
LLCC Financial Aid Office
Call 217.786.2216 or
5250 Shepherd Road
800.727.4161, ext. 62216
Springfield, IL 62794-9256
VA G.I. BILL ENROLLMENT FORM
veterans.affairs@llcc.edu
217.786.2229 fax
Student Information
STUDENT NAME (LAST, FIRST, MIDDLE INITIAL)
SSN OR STUDENT ID
ADDRESS
CITY
STATE
ZIP
PHONE NUMBER (INCLUDE AREA CODE)
EMAIL ADDRESS
VA APPROVED PROGRAM OF STUDY
Benefits
Initial the Federal Benefit (G.I. Bill) which you are using. (Ask if unsure.)
Montgomery G.I. Bill (Ch. 30) - Active
Post 9/11 G.I. Bill (Ch. 33)
o
o
Montgomery G.I. Bill (Ch. 1606) - Guard/Reserve
Post 9/11 G.I. Bill Transfer of Entitlement (Ch. 33)
o
o
Montgomery G.I. Bill (Ch. 1607) - REAP
Vocational Rehab (Ch. 31)
o
o
Survivor/Dependent (Ch. 35)
o
If you selected Chapter 33-Post 9/11 G.I. Bill, answer the following questions:
How many months of eligibility are remaining? ________________________________________________________________
Percentage of benefit entitlements: _________________________________________________________________________
Have you changed your approved program of study?
Yes
No
o
o
IF YES, what is your new program of study? ___________________________________________________________________
Advisor Comments
Include course schedule and if course is not part of student’s program:
Repeat class(es) (if any)
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