Veterans' Certification Data Form (Page 2 of 2) in pdf

Current semester courses: Please list your courses for this semester in the table below. All hours pursued must apply toward your Degree Program or

be a required prerequisite to a course in your Degree Program. All courses added, dropped or audited must be reported to the LC Financial Aid Office

immediately. Please note that VA will not pay for Audited Courses, courses that do not fulfill graduation, and repeated courses that have been

successfully completed.

COURSE & NO.

REPEAT?

HOURS

COURSE & NO.

REPEAT?

HOURS

YES

Any repeats:

YES

If YES, explain why:___________________________________________________________________

_________________________________________________________________________________________________________________

Please note that payment may be received 4-12 weeks after certification is received by the Veterans’ Regional Office.

The course(s) listed above lead toward my degree. I understand that only “F” grades or courses that have to be completed with a certain grade or grade

point average can be repeated. I hereby authorize VA Certifying Official to release information to the Veterans’ Administration concerning my status as a

VA student at LC. I will immediately notify the Certifying Official of all changes that occur in my enrollment. I understand that failure to do so

may result in a delay of payment of my benefits or an over-payment with VA. I also understand that if I choose to stop attending my classes, VA will be

notified, and this may also cause an over-payment with VA.

Veterans Affairs Office: 1-888-442-4551 or to check status of benefits, to print form/application or if you have questions. Each VA

student will be mailed a copy of their electronic certification once this form has been processed. Please allow 2-3 weeks for processing. Make sure

that the courses on this data form match your actual schedule. Also, complete this form if at anytime you add a class or drop a class, please

submit a copy of your schedule. If this form is incomplete or necessary documents aren’t attached, this will cause a delay in certification.

I have read and understand the above paragraphs and, I will continue to check my LC email account for updates and information.

________________________________________________________________

________________________________

SIGNATURE

DATE

To be completed by student’s academic advisor:

This student is taking required courses toward his/her degree plan. If the student is repeating a course, state the reason why below: