VA Certification Request Form ‣ Laurel Ridge Community College

Your Information

Name*

First Last

Email*

Enter Email Confirm Email

Laurel Ridge Student ID Number*

Benefits

Are you a new student at Laurel Ridge?*

Yes
No

Is this your first semester using Military benefits at Laurel Ridge?*

Yes
No

Are you a Guest Student (taking courses at another college) at Laurel Ridge?*

Yes
No

As you are a guest student, please indicate the name of your parent school:*

Semester you are requesting certification for:*

Spring
Summer
Fall

Please select your Benefits Chapter(s):*

You may select more than one.

Chapter 30 (MGIB)
Chapter 31 VR&E
Chapter 33 (Post 9/11)
Chapter 35 (Dependents)
Chapter 1606 (Reservist)
Tuition Assistance - Federal
Tuition Reimbursement - VANG
VMSDEP

Do you want your VA benefits to cover all of your classes this semester?*

Yes
No
Unsure

Program of Study

Program Name*

If unsure, please view the programs offered at Laurel Ridge at laurelridge.edu/pathways.

Tuition Payments

How do you plan to pay your tuition? Please select all that apply:

Cash, Check, Credit
Anticipated Financial Aid
Chapter 31 VR&E
Chapter 33 (Post 9/11)
VMSDEP Benefits
Tuition Assistance

Required Statements

By marking each statement below, you certify that you have read and agree to the following:

Courses and Progress*

I understand that I can only receive benefits for courses required for my degree or certificate program and I must make satisfactory progress toward graduation/completion.

I agree

Student Responsibilities*

• I understand the VA determines benefit eligibility and payments.
• I understand it is my responsibility to know what benefits I have.
• I understand I must notify the military benefits official of any enrollment changes I make.
• I understand any enrollment changes I make may result in a debt to Laurel Ridge and/or VA.

I agree

Form Requirements*

I understand this form is required every semester I want to use military education benefits. My courses will not be certified with the VA if this form is not completed.

I agree

Full-Time Status*

I understand that full time status is different for summer enrollment.

I agree

Form Questions*

If I have any questions about the information on this form or about my military benefits, I will speak to the military benefits official or call the VA Education Hotline: 1-888-442-4551.

I agree

Post 9/11 (Chapter 33) Recipients - BAH*

• My housing allowance (BAH) rate is determined by my rate of pursuit and what location I take equal or majority of my in-person courses. The US Department of Veteran Affairs calculates all BAH (housing stipends) amounts. For more information 1-888-442-4551
• I must verify my attendance with the VA. If I fail to verify my enrollment for two consecutive months, my BAH will not be paid to me.
• For more information, GI Bill enrollment verification information.

I agree

Post 9/11 (Chapter 33) Recipients - Financials*

• I understand, tuition and fees will be paid by VA directly to Laurel Ridge approximately 3 weeks after the drop period.
• To avoid delayed disbursement of my financial aid, I must provide my certificate of eligibility prior to the first day of the term of enrollment. Otherwise, my financial aid will be applied to my student balance.

I agree

Post 9/11 (Chapter 33) Recipients - Enrollment*

• Once initial enrollment is submitted to the VA, I can make enrollment changes. However, I understand any changes cannot be reported to the VA until after the drop period ends.

I agree

Please include any comments or questions regarding this form:

Please enter your full name below. In doing so you agree to the guidelines and statements submitted via this form:*

Name

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