PQC VA Benefit Request Form

VA Education Benefits Request Form (VBRF)

Paul Quinn College
This form is required for any student requesting enrollment certification of Veteran Educational Benefits for EVERY SEMESTER that you wish to receive VA Benefits. This is to verify that the classes you are requesting to be certified for with the Department of Veteran Affairs will apply towards your degree/major/minor requirements.

All students must notify the VA Certifying Official in the Office Of Financial Aid if ANY of your courses change or if you withdraw and/or apply for an incomplete (or extension for “I” grades) in any course. Course changes could lead to debt owed to the VA.

All students must further understand that any “NP” or other “non‐punitive” grade(s) received will be reported to the VA and the student will be responsible for any overpayment/debt this may cause. Non-punitive grades are those that do not earn credit towards your degree. An example of this may be withdrawal after the drop period.

Questions can be directed to finaid@pqc.edu

Name*

First NameMiddle NameLast NameSuffix
Student ID*
example: A0000123456
Email*
example@pqc.edu
Phone Number*
Please enter a valid phone number.

Please note if there are any courses that you are not requesting to be certified for VA Benefits proposes.*
Do any of your classes you submitted NOT apply to your degree program? Please select one.*

All classes apply to my degreeSome classes apply to my degreeNone of my classes apply to my degree

Acknowledgement

By submitting this form I understand that this is a formal request to have my enrollment certified to the VA. I understand that in order to have my enrollment certified my eligibility documents must be submitted to the Office of Financial Aid - Veteran Certifying Official.

I understand that it is my responsibility to ensure that the courses meet my degree objective and that courses outside of my degree program will not be certified.

I understand that changes in my enrollment must be reported through another VBRF and that course changes could lead to debt owed to the VA.

I understand that non-punitive grades (a grade that doesn't earn credit towards your degree) may impact my benefits and could lead to debt owed to the VA.. An example of this may be withdrawal after the drop period.

I understand that certification timeline may vary based on Census date.

By typing in my name, I acknowledge that I have read and understood the statements above.
Signature*

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