Applying For Va Benefits Veterans Intent To Register Application (Page 2 of 4) in pdf

VETERAN’S INTENT TO REGISTER

This form must be completed for EACH SEMESTER and returned to the VA Certifying Official in the Financial Aid Office

prior to the beginning of the semester. FAILURE TO DO SO MAY DELAY BENEFITS. Please print or type your answers.

Name_____________________________________________________________________________________

Social Security #________________________________ TSJC Student ID#______________________________

Address____________________________________________ City_______________ State____ Zip________

Telephone #____________________________________________ Date of Birth ________________________

E-Mail Address______________________________________________________________________________

(Is this your current address on VA records? If not, call Education Benefits at 1-888-442-4551 to change your address.)

THIS SECTION MUST BE COMPLETED FOR CERTIFICATION

# Fall hours _______

# Spring hours _______

# Summer hours _______

Program Name_______________________________Degree__________ Certificate_________

CHECK ONE: _____New Student (never attended college) _____Continuing at TSJC Student _____Transfer Student

CHECK ONE:

_________Chapter 33 – Post-9/11

_________Chapter 30 (Montgomery GI Bill) ____________Terminal Leave Date

_________Chapter 32 (VEAP)

_________Chapter 1606 (National Guard/Reserves) or

_________Chapter 1607 (REAP)

_________Chapter 35 (Dependent Spouse/Child) Claim #___________

_________Chapter 31 (VA VOC Rehab)

STATEMENTS OF UNDERSTANDING

1. I understand that I must attend 12 or more credit hours every week of the semester that pertain to my program

as outlined in the school catalog to receive full-time educational benefits.

2. I agree to report all enrollment changes to the VA Certifying Official at TSJC. A change of schedule may result in

an over payment. All over payments are expected to be repaid. IT IS MY RESPONSIBILITY TO REPORT ALL

SCHEDULE CHANGES TO THE VA CERTIFYING OFFICIAL.

3. I must strictly adhere to course requirements outlined in the school catalog under which I enroll. The VA will not

pay for duplicate courses or courses not required for my degree. VA will only pay for repeated courses that are

required to overcome a grade point deficiency for graduation.

4. I consent to the release of information from my academic records necessary for VA certification.

5. I understand that this office cannot determine eligibility, but can assist in the submission of applications and

supporting documents. The primary function of this office is to certify and report enrollment information to the

VA to facilitate the receipt of benefits by eligible students.

I HAVE READ AND UNDERSTAND THE ABOVE-STATED REQUIREMENTS REGARDING MY EDUCATIONAL BENEFITS.

Student’s Signature_________________________________________________Date___________________

Trinidad Campus: 600 Prospect Street, Trinidad, CO 81082

Alamosa Campus: 1011 Main Street, Alamosa, CO 81101

719-846-5553 (Office); 719-846-5420 (fax)

719-589-7024 (Office); 719-589-7005 (fax)

Applying For Va Benefits Veterans Intent To Register Application Page 2