VA Certification Request Form ‣ Laurel Ridge Community College

Your Information

Name*

First Last

Email*

Enter Email Confirm Email

Laurel Ridge Student ID Number*

Your Laurel Ridge Veteran Academic Advisor:*

Jeanmarie Corrado
Sharon Painter

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 or Virginia National Guard)
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 (must submit approval before drop date)

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 my advisor 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

Contact Information*

I authorize the School Certifying Official to update my contact information and/or program of study with the college on my behalf using the info on this form.

I agree

Form Questions*

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

I agree

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

• My BAH rate is determined by my full-time student status and what location I take equal or majority of my in person courses.
• Effective December 17, 2021, 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.

I agree

Post 9/11 (Chapter 33) Recipients - Financial Aid*

If I choose to use Financial Aid and Chapter 33 post 9/11 in the same semester, it is my responsibility to coordinate with my veteran advisor.

I agree

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

Phone

This field is for validation purposes and should be left unchanged.