Veteran Enrollment Request to Certify "*" indicates required fields This form is used by students who wish to request the use of their Veteran Education Benefits. Students must be registered for classes for the semester in which they wish to receive benefits before completing this form.This request is for: * Required Summer Fall Spring Section 1: Student Information91涩漫 Tech ID or StarID: * RequiredName * Required First Last Address * Required Street Address Address Line 2 City State AlabamaAlaskaAmerican SamoaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahU.S. Virgin IslandsVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific ZIP Code Phone * RequiredEmail * Required Enter Email Confirm Email Section 2: Benefits ProgramIs this your first time receiving benefits at 91涩漫? * Required Yes No If you have not already done so, please complete a Veteran Information Sheet.If your last enrollment at Lake Superior College was more than one year ago, please complete a Veteran Information Sheet.Benefit Program: (Select One) * Required Chapter 30 - Montgomery GI Bill Chapter 31 - Veteran Readiness and Employment Chapter 33 - Post 9/11 Bill Chapter 35 - Survivor/Dependent Chapter 1606 - Montgomery GI Bill Selected Reserve Other (explain in Notes) VR&E Counselor: * RequiredPercent of Eligibilty (40-100): * RequiredVA File #: (If you have been certified before at Lake Superior College, enter "On file" in the box below) * RequiredNotes: (Include any other funding you will be receiving)Veteran's NameSection 3: Enrollment InformationProgram of Study (NOTE: The VA will only allow certification of courses that are required for your declared program at 91涩漫.): * RequiredNumber of credits you are taking this semester: * RequiredAre you graduating at the end of this semester? * Required Yes No Section 4: Student Responsibility - PLEASE READ BEFORE SUBMITTINGI understand that it is my responsibility to notify the School VA Certifying Official in a timely manner as to any changes to the information above. Any adjustments that I make to my enrollment may result in a change in the benefits I am eligible to receive from the Department of Veteran Affairs for my education. I understand that I am responsible for repayment to Lake Superior College and/or the Department of Veterans Affairs for any overpayment or debt that may occur from any adjustments made to my enrollment. I understand that I am responsible for any balances at Lake Superior College that are not directly covered by my benefits, including but not limited to bookstore charges and late fees. By signing this document, I request that my enrollment information be sent to the Department of Veteran Affairs for the term(s) designated above. I understand the Department of Veteran Affairs will only recognize, and I will only receive benefits in accordance with, courses that are taken to satisfy my declared program. I also understand that I will be personally responsible for any tuition and fees associated with courses that do not meet the Department of Veteran Affairs鈥� standards. I also understand that I am responsible for monitoring my remaining veteran benefits, as the school is not privy to this information.I understand the above statement. * Required Agree
