Request for Veteran Certification

Request for Veteran Certification

Wharton County Junior College
Students must complete this Request for Veteran Certification form each semester for which they want to use VA or Hazlewood Benefits at Wharton County Junior College.
Year:
Semester (check one):

FallSpringMini (May orDecember)Summer
Last Name:
First Name:
WCJC Student ID Number:
Address:
Branch of Service:

ArmyNavyAir ForceMarine Corp.Coast GuardNational GuardN/A
WCJC Student Email Address (All correspondence will be sent to student email):
Phone Number:
Major:
Are you a new or returning WCJC VA student?

NewReturningN/A
Are you a new or returning WCJC Hazlewood student?

NewReturningN/A
Are you a guest student?

YesNo
Name of parent institution (if applicable):
Check benefit requested:

CH.30-MGIB ®CH.31-VRECH.33 – Post 911®CH.1606CH.35 – DEAHazlewood VeteranHazlewood LegacyHazlewood Dependent/Spouse of a 100% disabled Veteran
If CH.30-MGIB®, Percent:
%
If CH.33 – Post 911®, Percent:
%
If CH.35 – DEA, File # (must complete):
If Hazlewood Veteran, Percent:
%
If Hazlewood Legacy, Percent:
%
If Hazlewood Dependent/Spouse of a 100% disabled Veteran, Percent:
%
Read and check each item below

It is my responsibility to complete a Request for Veteran Certification form each semester I wish to use my VA/Hazlewood benefits at WCJC.The VA will only pay for classes in my degree plan. If I change my major, I will notify the WCJC Veteran Certifying Official before doing so.If I change my schedule, drop, withdraw, etc., I must contact the WCJC Veteran Certifying Official immediately at veterans@wcjc.edu.
By typing my name and submitting this form, I acknowledge that I have read and understand the above statements.
Name:
Date:
Should be Empty: