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VA Certification Request
Form
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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.
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