Semester Benefit Request - Cochise College printable pdf download

COCHISE COLLEGE SEMESTER BENEFIT REQUEST

THIS FORM MUST BE TURNED IN EVERY SEMESTER

NO CERTIFICATION OF ENROLLMENT WILL BE SENT TO THE VA UNTIL ALL PRIOR MILITARY

AND CIVILIAN TRAINING HAS BEEN RECEIVED AND EVALUATED BY COCHISE COLLEGE

AND THE VETERANS PRIOR TRAINING REVIEW COMPLETED WITH ADVISING.

Print clearly, if we cannot read the information, then enrollment may not be sent to the VA.

Last Name _____________________________________ First _______________________________________

Address _______________________________________________________________________________

City ____________________________________________________ State ________ Zip __________________

Phone (H) ________________________________ (W) ___________________ Cell ____________________

SSN _______________________________________ Student C Number ______________________________

Chapter 35, Dependent Education Assistance ONLY Sponsors Claim #/SSN __________________________

Email Address: __________________________________________________________________________

In general, VA does not pay for classes that are self-improvement or recreational in nature,

nor does VA pay for excess electives. Because veteran students are awarded HPE credit

based on their military service, benefits will not be paid for Health and Physical Education.

TRANSFER STUDENTS

If you are transferring to Cochise College from any other school, where you used your Veteran’s

Benefits you are required to submit a “Change of Program Form”, VA From 22-1995 for Veterans, or VA

Form 22-5495 Survivors/Dependents at

Are you a transfer student?

YES

If yes have you completed the VA From 22-1995 for Veterans, or VA Form 22-5495

YES

NO If you checked NO the VA will not pay benefits until you complete this form.

Have you completed the veterans prior training review with advising?

YES

GUEST/VISITING STUDENTS

If are receiving VA educational benefits at another school, you must turn-in a “Parent School Letter” with this

form before enrollment certification is sent to the VA.

Are you a guest student

YES

PLEASE CHECK THE VA EDUCATIONAL BENEFITS YOU ARE APPLYING FOR: (CHECK ONLY ONE)

Chapter 33 Post 9/11

Chapter 30 (MGIB)

Chapter 1606 (Reserve/National Guard)

Chapter 31 (Vocational Rehab)

Chapter 1607 (REAP- Activated reserve/Guard)

Chapter 35 (Dependent Education Assistance)

Chapter 31 Students Only:

I do

do not

give permission for my end of semester grades and GPA to be sent to my

Vocational Rehabilitation counselor.

Semester Benefit Request - Cochise College