VA Benefits Certification Form
This authorization is required for all persons who will be receiving VA Educational Benefits. If SMWC does not receive this form each semester, we will NOT certify student VA benefits.
Student ID #
*
Name
*
First Name
Last Name
Address
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Select the VA Chapter you will be using:
*
Please Select
Chapter 30 (MGIB Active Duty)
Chapter 31 (Vocational Rehab)
Chapter 33 (Post 9/11 GI Bill)
Chapter 35 (Dependent of Qualified Veteran)
Chapter 1606 (MGIB Reserve/Guard)
Chapter 1607 (Eligible Reserve/Guard)
What semester is this request for?
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Fall
Spring
Summer
How many credit hours are you enrolled in for the semester selected above?
*
What is your major or degree program?
*
Are you receiving Tuition Assistance or the National Guard Tuition Grant?
*
Yes
No
Please read each statment below and indicate that you understand.
*
I understand that I will be liable for any overpayment that I might receive from the VA.
I understand I will notify the VA Coordinator if I change, withdraw, or drop from any course once this form has been submitted.
I understand I am aware that I need to complete this form each semester and submit it AFTER I register for classes. Submitting prior to registering could delay the certification of my courses.
I certify that all of the information above is correct and I agree to the above statements.
*
Submit
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