Veteran's Request For Certification of Educational Benefits

Veteran's Request For Certification of Educational Benefits

OFFICE OF VETERANS AFFAIRS - FLETCHER TECHNICAL COMMUNITY COLLEGE
Phone: 985-448-7900 | Fax: 985-448-7998| Email: financialaid@fletcher.edu

Complete & submit this form AFTER you have registered for classes. Students must be in a degree seeking program to receive VA benefits. This form is required EACH semester for undergraduate students in order to receive monthly educational benefits.
Name*

First NameLast Name
Today's Date*

MonthDayYear
Date
Address*

Street Address

Street Address Line 2

CityState

Zip Code
Fletcher ID:*
Phone Number*
Please enter a valid phone number.
Email*
example@example.com
Major*
Are you currently Active Duty?*

YesNo
VA File Number (Your SSN OR if you are a dependent—the SSN of your Veteran): *
Please indicate which benefit you are applying for or currently receive(select all that apply):*

Chapter 30- Active DutyChapter 31- Vocational RehabilitationChapter 1606- ReserveChapter 33- Post 9/11 ________%Chapter 35- Survivors and DependentsTitle 29 Tuition Exemption
Chapter 33-Post 9/11 %:
Which semester are you applying to use your benefits? (Select the current semester only)*

FALLSPRINGSUMMER
List all the courses you are enrolled in. The information for your courses can be found on your Concise Schedule in LoLA.Configurable list*
Who's your enrollment specialist?
If you are unsure please email enrollment@fletcher.edu
I agree to promptly inform the Certifying Official of any changes in my status. I understand that I will be responsible for any debts I incur from the VA and / or FTCC due to my changes in academic information. I understand that the VA does not pay for: more than one degree, course(s) not in my degree curriculum, dropped courses, audited course(s), course(s) already successfully completed (according to degree curriculum), and repeated course(s) for raising GPA. I know that unsatisfactory progress (academic probation and suspensions), dropped classes, resignations and non-attendance will be reported to the VA and may cause an overpayment.
Student Signature*

Clear
Should be Empty: