Georgia Perimeter College Veterans Certification Request Name

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GEORGIA PERIMETER COLLEGE
VETERANS CERTIFICATION REQUEST
NAME:
GPCID# 900
TERM
:
ADDRESS:
CITY:
ZIP
PHONE (
)
SOCIAL SECURITY:
IF NOT
[ ] Check here if your VONAPP (Veteran’s ON-line Application) has been submitted online.
, please attach:
Veterans & Reservist: VA Form 22-1990 (Applying for the first time) OR VA Form 22-1995 (Transfer Students)
Dependents or Spouse: VA Form 22-5490 (Applying for the first time) OR VA Form 22-5495 (Transfer Students)
(CHECK VA CHAPTER)
CH. 30 (GI BILL)
CH. 1606 (RESERVE/GUARD)
CH. 1607 (REAP)
CH.31 (VOC. REHAB)
___ CH. 35 (DEPENDENT/SPOUSE) VA FILE NUMBER
(Required for CH. 35)
st
nd
rd
I am the 1
2
3
dependent to use benefits. (Circle One)
[ ] Check here if you are applying as a spouse.
Have you ever used your VA benefits at Georgia Perimeter College? NO
YES
Since your last enrollment, have you changed your program/major? NO
YES
If, YES, please
complete and attach the “Request for Change of Program” which is VA Form 22-1995 for Veterans/Reservist OR
VA form 22-5495 for Dependents/Spouse.
PROGRAM OBJECTIVE:
YOUR PROGRAM MUST AGREE WITH THAT LISTED IN THE COLLEGE’S OFFICIAL RECORD AND MUST
CORRESPOND WITH THE MAJOR LISTED ON YOUR APPLICATION FOR VA BENEFITS.
PLEASE REVIEW THE FOLLOWING INFORMATION:
I understand that every semester I register, I am responsible for paying my own tuition and fees
(except for Chapter. 31 Vocational Rehabilitation). Initials:
I understand that I will only be certified for courses that will apply toward my current degree program at
GPC (Please print advisement form from GPC’s website). If I drop, withdraw, or audit a course(s) my
certification will be adjusted immediately without written notification. Initials:
I am requesting that the VA Office (Authorize/Not Authorize) all payments at break time that
(Circle One)
occur in between semesters. I understand that if I authorize payments during break time, I will use up my
VA benefits at a faster rate. I understand that if I don’t authorize payments between break times, I will not
be getting my full benefits for any month that break time occurs. This decision will remain in effect until I
notify the VA Office otherwise in writing. Initials:
If you are a Chapter 30 (Montgomery GI Bill/Active Duty) student, the VA will not pay for any physical
education courses. Georgia Perimeter College will give you 3 credit hours for the required courses. This
includes PHED 1101 (Choices for Life). Reservists that have served more than 180 days on active duty
are also eligible for this exemption. Please submit a copy of your DD214 to the Registrars office to be
granted credit. Initials:
STUDENT SIGNATURE
DATE
DO NOT SUBMIT THIS FORM OR OTHER DOCUMENTS UNTIL REGISTRATION IS COMPLETE

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