Quarterly Veterans Center Benefits Request Form (Page 2 of 2) in pdf

Quarterly Veterans Center Benefits Request Form Page 2

ENROLLMENT INFORMATION:

Indicate your Major (or Double Major):__________________________ Your Minor:__________________

I intend to enroll in ______ units for the above quarter. I request certification for these units. By sign-

ing this form, I acknowledge that I am submitting my intent to enroll. I am aware that I must notify a

VA programs specialist in the UCSB Office of the Registrar if my actual enrollment does not match

the enrollment I have submitted.

*Be sure to include a copy of your current schedule approved by your academic advisor.

Class level:

❑ FRESHMAN

❑ SOPHOMORE

❑ JUNIOR

❑ SENIOR

❑ 2

B.A.

❑ GRAD STUDENT

❑ Please process “Advance Pay” for this term.

For more detailed information go to or contact

the VA directly at (888) GIBILL-1.

STATEMENT OF CERTIFICATION:

I agree to notify the Office of the Registrar, Veterans Educational Benefits, at the University of California

at Santa Barbara immediately of any change in units or program status, including termination of my

enrollment. In the event that I receive an overpayment from the U.S. Department of Veterans Affairs

as a result of my negligence in reporting any changes of status, I agree to repay the amount of such

overpayment to the U.S. Department of Veterans Affairs. I also agree to only request Veteran’s Benefit

certification for units which fulfill my major/degree requirements. In the event that any said units are

found unnecessary for my degree program, I agree to repay the Veterans’ Administration the amount

which is owed to compensate for those un-certifiable units.

Student’s Signature

Date

Return this completed form to:

UCSB Office of the Registrar

Attn: Veteran’s Benefit Program

1101 SAASB

Santa Barbara, CA 93106-2985

For questions, email:

Reg-Veterans-Benefit-Programs@sa.ucsb.edu

or call:

(805) 893-8905

RM 1/12/09

Quarterly Veterans Center Benefits Request Form Page 2