Veterans Statement of Intent

It is your responsibility to return this form each semester to be certified for VA benefits.

IMPORTANT: YOU MUST REGISTER FOR YOUR CLASSES BEFORE SUBMITTING THIS FORM!

Instructions: Complete this form for each semester that you would like to claim benefits from the VA. The completion of this form authorizes the Registrar to provide required information and to certify your enrollment at Emmaus for a specified semester to the US Department of Veteran Affairs (DVA). Failure to complete this form correctly may delay or prevent your enrollment certification. Changes in your registration, credit hours, or major must be reported immediately to the Registrar at Emmaus.

Name*

First NameLast Name

Student ID #*

Address as reported to the VA*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code

Email*

To maintain student confidentiality, Emmaus Veterans Affairs will only communicate with students using their Emmaus student email address.

Choose the VA Chapter from which you receive your benefits:*

Name of your Emmaus degree program:*

NOTE: The VA will not pay benefits for any class not required in your degree program.

Check semester you are requesting to receive benefits*

FallSpringSummer

List the courses you are taking this semester*

	course code	section #	course name	credit hours
course 1
course 2
course 3
course 4
course 5
course 6
course 7

The dollar amount G.I. Bill Educational benefits may be affected by dropping or adding classes, enrolling in an unauthorized repeat of a class, enrolling in courses not authorized under the general education requirements or degree program designated on your current Veterans Plan of Study.

Receiving non-punitive grades may result in an overpayment by VA. Non-punitive grades are grades that do not count toward graduation and include: “W”, “WP”, “WF”, “I “and failing grades from non-attendance. Students, who receive an “I” in a course, must notify the Emmaus Registrar once the course is completed and a letter grade is issued.

Enrollment status is determined by the number of credits certified. Credits taken but not certified will not be considered by the VA when calculating benefit rates.

I verify that the preceding courses, which I have listed and have registered for, are required in the above stated program of study; they have not been successfully completed previously nor have I received transfer credit for them. I will notify the Registrar/Veterans Affairs Office at Emmaus Bible College of any change in my enrollment (including credit hours).

Student's Signature*