Veterans' Certification Data Form printable pdf download

Louisiana College Financial Aid Office

1140 College Drive

Tel: (318)487-7386 Fax: (318)487-7449

Pineville, LA 71360

VETERANS’ CERTIFICATION DATA FORM

Fall 20__

Spring 20__

Summer 20__

Is this a revised schedule?

YES

NAME:_________________________________________________________

SSN:_________________________________________

Student ID#:__________________________________

ADDRESS:______________________________________________________

Major/Degree Plan: ____________________________

Graduation Year:______________________________

CITY:__________________________STATE:________ZIP CODE:_________

TELEPHONE (H): ______-______-_____________ (W):______-______-_______________ EMAIL:________________________________

Check box if this is a new/updated address, phone number or email address

New Student: When and how was your application

VONAPP

Mail—date?____________

submitted?

Transfer Student: (Request an official transcript from your previous institution(s) and complete Change of Training Place FORM #22-1995.

Unable to certify students without this form.)

Visiting Student—Primary Institution:__________________________ (Submit a letter from your primary institution

stating that the credit(s) that you are taking at LC will be accepted.)

Returning Student—Last term attended at LC:___________________

(Complete FORM #22-1995)

CHANGED DEGREE PROGRAM FROM_________________________ TO ____________________________

CLASSIFICATION:

GRAD

Do you have a degree?

YES

If yes,

2 yr or

4 yr

VA ELIGIBILITY:

Ch 30 (Montgomery GI Bill)

Ch 31 (VA Voc Rehab)

Ch 32 (VEAP)

Ch 33 (Post 9/11 GI

Bill)

Ch 35 (Dependent of Vet**)

Ch 1606 (Reserves/Guard)

Ch 1607 (REAP)

**Note to Chapter 35 Student, please provide following information:

Name of VA Parent/Spouse:_____________________________________ PHONE #_____________________

SSN #_____________________________________________ VA File #________________________________

Please list any other type of funding paying for tuition/fees. Example: Federal Grant, Loan, Outside Scholarship, TOPS

________________________________________________________________________________________________________________________

Are you VA Work-Study? If so, you will need to coordinate job with VA Certifying Official at LC. Application for Work-Study Allowance

available in Financial Aid Office or

NOTE TO:

2. New Student or Never Used VA Benefits

3. Transfer Student – Used VA

1. All VA Students

Before

Benefits Before

1. Used benefits before: complete and

1. Complete and submit this VA Data Form each semester with your

If you have never used your benefits:

submit VA Form 22-1995.

advisor’s signature.

1. Complete and submit Form 22-1990 at

2. Indicate any course repeats and tell why (include W and F grades.)

22-1995-ARE.pdf

3. All students except for Chapter 31, 33 & 35, need to verify your

2. Complete and submit this VA Data Form each

2. Complete and submit this VA Data

hours at the end of each month at

semester with advisor’s signature.

Form each semester with advisor’s

or call

signature.

1-888-GIBILL1 (442-4551)

4. Register early to avoid delay in benefits.

6. All Post 9/11 students must submit a copy of Certificate of Eligibility

Veterans' Certification Data Form

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