Va Benefit Certification Request - Delgado Community College
ADVERTISEMENT
1
2VA Benefit Certification Request
Note: This form must be completed EVERY semester. An Enrollment Verification (VA Form 22-1999) is created once this form is
submitted. Incomplete or inaccurate information will cause delays. You must have a class schedule before completing this form.
First Name:
Last Name:
LoLA #:
Social Security #:
VA File # (Required for Ch. 35 users):
Address:
City:
State:
Zip:
Home Phone #:
Cell Phone #:
Email Address:
Alternate Email Address:
Primary Major (Must be listed in LoLA):
Secondary Major (Must be listed in LoLA):
□ New Student: (Never used VA Education Benefits before)
□ Returning Student: (Used VA Education Benefits at Delgado before)
Student
□ Transfer Student: (Used VA Education Benefits at another school) Complete VA Form 22-1995 or 22-5495
Status:
□ Guest Student: (Using VA Education Benefits at Delgado and another school) Please provide a parent letter
Are you using LA National Guard Tuition Exemption?
□ Yes
□ No
*(Speak with the bursar’s office every semester to use this benefit)
Are you using LA Dependent’s Tuition and Fee waiver certificate?
□ Yes
□ No
*(Must present this certificate to the bursar’s office every semester)
Are you being charged out of state fees?
*(Post 9/11 GI Bill does not cover out
□ Yes
□ No
of state fees. You are will be responsible for these fees)
□ Post 9/11 GI Bill (Chapter 33)
□ Montgomery GI Bill – Active Duty (Chapter 30)
Please select
□ Vocational Rehabilitation (Chapter 31)
the benefit
□ Survivors’ & Dependents’ Educational Assistance (Chapter 35) VA File #________________
you are using:
□ Montgomery GI Bill – Selected Reserve (Chapter 1606)
□ Reserve Educational Assistance Program (Chapter 1607)
□ Fall
□ Spring
□ Summer
Semester:
Year
20____________
ADVERTISEMENT
0 votes
Related Articles
Related forms
Related Categories
Parent category: Legal