Veteran Services | Benefit Certification Form - Jackson College-全球网络赌博平台

Personal Information

Name *

Address *

Phone *

Email *

Student ID *

Social Security # *

Chapter

Select Your Chapter (Need to submit sponsor name and SSN for initial submissions)

Chapter 30 Montgomery GI Bill® / VRAP
Chapter 31: Vocational Rehabilitation and Employment (VR&E)
Chapter 33 Post 9/11
Chapter 33T: Transfer of Entitlement
Chapter 35 Survivor's and Dependent Assistance Program
Chapter 1606 Selected Reserve

Percentage (%)

Sponsor Name

You only need to provide this information if this is the first time you've filled out this form.

First Last

Sponsor Social Security #

You only need to provide this information if this is the first time you've filled out this form.

Are you on active duty?

Yes
No

Are you receiving Federal or State Tuition Assistance?

Yes
No

Are you receiving Federal or State Tuition Assistance?

Yes
No

VA File #

Are you utilizing Military Tuition Assistance or MYCAA.

Yes
No

Degree Plan

Degree *

If this is a change in degree from your previous semester, please fill out a Change of Program/Place of Training Form and return it to your VA Certifying Official in order for your enrollment to be certified.

Type of Student

New Student (I have never used my VA Education Benefits and have not attended a College or University)
Returning Student
Transfer Student
Visiting Student

Returning Student Additional information

I have never used my VA education benefits
I HAVE used my VA education benefits

Transfer Student Additional Information

I have never used my VA education benefits
I HAVE used my VA education benefits

Name of Parent School:

Are you using a scholarships such as th Tuition Assistance Program, Future for Frontliners, Michigan Reconnect or other funding source that is not the Pell grant?

Yes
No

Classes

For which semester are you requesting your enrollment to be certified with the VA? *

Year *

Is this your initial certification for the above semester? *

Yes
No

If no, which of the following changes apply:

Change of classes
Change of program

Student Veterans of America

I am interested in the Student Veterans of America group at Jackson College

Questions or comments

Confirmation

Confirmation 1 *

I have read, understand, and submitted the VA Responsibility Form.

Confirmation 2 *

I understand that all correspondence will be sent to my JC Email account.

Confirmation 3 *

I confirm that all the information submitted here is accurate.

Benefit Certification Form

Personal Information

Chapter

Degree Plan

Classes

Confirmation

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