Va - Enrollment Data Form (Edf) printable pdf download

VA – ENROLLMENT DATA FORM (EDF)

(REQUIRED FOR EVERY TERM ENROLLED)

NAME:______________________________________________________________________________________

STUDENT # ____________________________________ PHONE # ___________________________________

E-MAIL: ____________________________________________________________________________________

MAJOR _____________________________________________________________________________________

Note: All courses being certified must apply toward your major on record. VA allows one major.

Which Chapter? ( ) CHAPTER 30 – Montgomery G.I. Bill (MGIB – AD)

( ) CHAPTER 33 – Post 9/11 G.I. Bill

( ) CHAPTER 1606 – Selected Reserves (MGIB-SR)

( ) CHAPTER 1607 – REAP

( ) CHAPTER 31 – Vocational Rehabilitation

( ) ACTIVE DUTY

( ) CHAPTER 35 – Survivors’ & Dependents’ Educational Assistance Program (DEA)

Note: You must be certain which chapter you claim benefits under. If in doubt, please contact the VA directly for

information.

Have you previously received VA benefits: ( ) NO ( ) YES If yes, list the last term you received benefits: ___________

Where you attending UM-St Louis the last time you received benefits? ( ) YES ( ) NO

If no, it will be necessary that you complete and return to my office VA Form 22-1995.

Term Being Certified: ________________________________________

Course #

Subject

Course Title

Credit

Required

Non- required

(Will not apply towards graduation

Hrs

Course

Elective

completion of above listed major)

NOTE TO ADVISOR: PLEASE DO NOT ALLOW STUDENTS TO HAND-CARRY FORM. PLEASE RETURN BY CAMPUS MAIL TO PEGGY BEMIS, 269 MSC.

ADVISOR PRINTED NAME _____________________________________________________________________

ADVISOR SIGNATURE __________________________________________________ Date:_________________

NOTE TO STUDENT: I HAVE READ AND FULLY UNDERSTAND WHAT IS REQUIRED OF ME AND WILL COMPLY WITH THE POLICIES AND PROCEDURES AS INDICATED. I UNDERSTAND THAT THE GRADE OF “Y”

OR “EX” WILL RESULT IN AN OVERPAYMENT OF BENEFITS, AND I WILL NOTIFY THE VETERANS OFFICE IMMEDIATELY. I ACCEPT PERSONAL RESPONSIBILITY FOR ANY OVERPAYMENTS MADE AND I AGREE TO

REFUND SUCH OVERPAYMENTS PROMPTLY TO THE VETERANS ADMINISTRATION REGIONAL OFFICE OR TO THE UNIVERSITY OF MISSOURI – ST. LOUIS. I FURTHER AGREE TO NOTIFY THE VETERANS AFFAIRS

OFFICE OF ANY CHANGES MADE TO MY SCHEDULE WITHIN 30 DAYS OF THE OCCURRENCE. IN ADDITION TO THE ABOVE, I AUTHORIZE THE INFORMATION FURNISHED ON THIS FORM TO BE RELEASED TO

THE VETERANS ADMINISTRATION REGIONAL OFFICE FOR VETERANS BENEFITS.

STUDENT SIGNATURE: ______________________________________________ Date: ________________