Va Intent Form Registration And Record

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VA INTENT FORM

BGSU – Registration and Records

Office Use Only: R / G /

Required Each Semester

110 Administration Bldg – First Floor

Fax # 419-372-7977

VAOnce ______Grad Year ______

College _________________

Submit to VA School Certifying Official

Major Code __________

Last Names A-J:

Rosetta M Day

Last Names K-Z:

Belynda S Hummel

rday@ bgsu.edu

bhummel@bgsu.edu

Campus: Main/Fire/Dist/Ecam

419-372-3843

419-372-7967

Resident / NonResident

NAME

Select One

_______

(Year)

_______ FALL

________________________________________________________________

(First)

(Middle)

(Last)

_______ SPRING

ADDRESS ________________________________________________________

_______ SUMMER

CITY/STATE/ZIP CODE _____________________________________________

SSN _______________________________ BGSU ID _____________________

STOP!

VA REQUIREMENT

BGSU Email _________________________PHONE ______________________

DID YOU SUBMIT YOUR

VONAPP?

VA’s Online

UNDERGRADUATE/GRADUATE MAJOR _______________________________

Application for Education

Benefits - One Time

______ FIRST YEAR BGSU

______ FIRST TIME USING VA BENEFITS

Application

ebenefits.va.gov/ebenefits/vonapp

Select the VA Education Benefit Program Awarded to You

_____Certificate of Eligibility Attached

_____ Chapter 1606 Montgomery GI Bill

_____ Chapter 1607 (REAP) Montgomery GI Bill Reserve/National Guard

(Reserve/National Guard)

Active Duty-Receiving Benefits on or before 11/24/2015

_____ Chapter 33 Post 9/11 GI Bill/Fry Scholarship/

_____ Chapter 30 Montgomery GI Bill (Active Duty)

Transfer Of Education-TOE Reserve and National Guard

_____ Chapter 31 Vocational Rehabilitation

Called to Active Duty and not eligible for REAP.

_____ Chapter 35 Spouse/Dependent of Veteran (DEA) GI Bill

VA File#__________________

By initialing, I understand the following conditions:

All scheduled classes I want certified to the VA must be a requirement for my current Major/Minor _______________

Any change in course enrollment after certification to the VA may result in the retroactive loss of benefits and could create a student debt. _______________

Adding and/or dropping classes may alter the payment the VA will award me and I will be liable for any overpayment I might receive from the VA _______________

I authorize the release of my academic transcripts to all parties to determine the continued use of my VA benefits _______________

The information provided by me is true and complete to the best of my knowledge and belief.

___________________________________________________________________________

____________________________

Signature

Date