Va Enrollment Certification Request & Drop/add Form
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1VA Enrollment Certification Request & Drop/Add Form
NORTHWEST FLORIDA STATE COLLEGE • Veteran Affairs Office
Name ____________________________________________________ ___
Student ID # _________________________
Address ___________________________________________________ ___
PH # _______________________________
City/State/Zip ______________________________________________ ___
Circle One: Fall Spring
Summer
Year ________
Address
Changed? Please notify the Dept. Veterans Affairs by phone, by email at ”Questions & Answers” link or the “WAVE” link at
Name of Program (i.e. AA-Business, AS-Nursing, Certificate-Acct Technology) ___________________________________________________________
(If POS is different from your last VA Certification submit new POS and request to change Program to VAO)
Do you graduate THIS semester at NWFSC?
Yes
No
Chapter Benefits:
Veteran (Ch. 30)
Active Duty (Ch. 30)
VEAP (Ch. 32)
Post 9/11 (Ch. 33)
Reservist (Ch. 1606)
REAP (Ch. 1607)
Dependent (Ch. 35)
VA Voc Rehab (Ch. 31)
Transient Student - Name of your Parent School? ______________________________________________
List only courses on POS you want certified.
If you have Mitigating Circumstances please provide documentation for VA.
Session
Course
Reference
Credit
DROP
ADD
Session
Number
Number
Number
Hours
Course
Reference
Course
Reference
Credit
Number
Number
Number
Number
Number
Hours
my degree.
I certify that I have read the “Notice” on the reverse and have verified that my classes are required by my Program of Study for completion of
Signature ______________________________________________________
Date ___________________________
An Equal Access/Equal Opportunity Institution
rev. 7/09
NOTICE TO STUDENTS RECEIVEING VA EDUCATION BENEFITS
I understand that all courses must apply toward my current NWFSC program, and that I must use this
form to report any changes to the NWFSC VA Office. I may also be required to submit a program change
to the NWFSC VA
(If POS is different from your last VA Certification submit new POS and request
to change Program to NWFSC
VAO). I understand that if I do not have a current program of study on
file in the NWFSC VA Office it may cause delay in my certification. I understand that if I withdraw from
You
classes and receive a non-punitive grade, I could be liable to the VA for an overpayment of benefits.
must submit this request EVERY semester to receive VA benefits.
As a recipient of VA Educational Benefits it is your responsibility to familiarize yourself with all related
information contained in the College Catalog, the Student Veteran Handbook, and other directives issued or
information released by the College. Failure to meet these responsibilities can result in the loss of your
educational benefits.
The NWFSC VA Office needs your assistance and cooperation if it is to serve you effectively.
NOTE: NOTIFY THE NWFSC VA OFFICE AND DEPARTMENT OF VETERANS AFFAIRS IMMEDIATELY OF ANY
CHANGE IN YOUR VA STATUS. THE VA TOLL FREE NUMBER IS 1–888–GIBILL–1 OR (1–888–442–4551).
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