Veteran Registration Certification Form
Contact Information
First Name
Last Name
Student ID #
Address
City
State
Zip Code
Phone
Email
Program Information
Degree Program
Degree Program Changed Since Last Semester?
Yes
No
Select Term:
Fall
Spring
Summer
Year
Round Up Semester?
Yes
No
Before submitting this form, you must:
Apply online using va.gov (
https://www.va.gov/education/how-to-apply/
) if this is your first time using GIBill® benefits. Provide proof of application or a copy of your Certificate of Eligibility.
Be registered for classes.
Review your degree to ensure all coursework applies to your degree. Contact your advisor if you have any questions about course applicability. Only applicable coursework will be certifiedforVABenefits.
Transfer and Re-Entry Students only:
Have you attended ANY SCHOOL under the GIBill® before?
Yes
No
Notify the VA of your change of program and place of training using form 22- 1995 on the Veterans Online Application website
https://www.va.gov/education/change-gi-bill-benefits/
.
Benefit Information
Military Status:
Active Duty
Veteran
Spouse
Dependent
If Active Duty, are you utilizing Tuition Assistance?
Yes
No
Branch of Service?
(Eligible Service members utilizing TA, must receive approval from an Educational Services Officer, or Counselor, within the Military Service prior to enrolling and email TA authorization to
vservices@germanna.edu
.)
Select Applicable Benefit(s):
Chapter 30 - Montgomery GIBILL® %
(Must have form of payment in place, i.e. pay out-of-pocket, payment plan, financial aid, etc.)
Chapter 31 - Veterans Readiness & Employment
(VRE Counselor must submit Purchase Order)
Chapter 33 - Post 9/11 GIBILL® %
(
Must verify enrollment each month
)
Chapter 35 - Dependent/Survivor (Federal BenefitOnly)
(1st semester ONLY): Best Phone # to Contact to Obtain File #)
(If only using Chapter 35, must have form of payment in place, i.e. pay out-of-pocket, payment plan, financial aid, etc.)
Chapter 1606 – Reserve/NationalGuard
(Must have form of payment in place, i.e. pay out-of-pocket, payment plan, financial aid, etc.)
VMSDEP - (Please checkVMSDEP and Chapter35 if you are utilizing both)
Must submit enrollment in
myVMSDEP
portal each semester to prevent classes from being dropped
MyCAA -
(Must provide Letter of Authorization. Email
vservices@germanna.edu
)
Marine GySGTJohn DavidFry Scholarship
Guest Student
Parent School
(Must submit letter from Parent school. Email
vservices@germanna.edu
)
Course Information
Course Dates
Course Name
Class Number
Section
Credit Hours
Access Fee?
Yes
No
Course Dates
Course Name
Class Number
Section
Credit Hours
Access Fee?
Yes
No
Course Dates
Course Name
Class Number
Section
Credit Hours
Access Fee?
Yes
No
Course Dates
Course Name
Class Number
Section
Credit Hours
Access Fee?
Yes
No
Course Dates
Course Name
Class Number
Section
Credit Hours
Access Fee?
Yes
No
Course Dates
Course Name
Class Number
Section
Credit Hours
Access Fee?
Yes
No
Acknowledgement Information
I understand that I must maintain satisfactory progress in order to continue receiving benefits.
I hereby certify that I have not received credit for any course for which I am registered.
I understand that the Veterans Administration will not award benefits for courses that are not accredited to my degree.
I agree to report immediately ANY enrollment changes made by me or by Germanna CC; including, ANY class changes, withdrawal from school, withdrawal and/or add/drop from courses or excessive class absences (according to the Academic Attendance Standard policy per GCC catalog) to the GCC MVSC. Failure to do so may result in reduction or termination of my benefits.
It is my responsibility to notify the GCC MVSC if I change my program of study (major), change my address, or take testing that will give me additional earned credits
It is my responsibility to submit a copy of my DD-214,Joint Service Transcript (JST), or Community College of the Air Force transcript (CCAF) to Admissions and Records for evaluation of military credits.
If I am transferring from another school, or have prior credits to submit for additional credit hours, I must submit all transcripts and/or notice of prior credits before the end of my second term at Germanna Community College. I am aware that if this information is not on record, VA regulations allow payments for two semesters only.
I understand that it is my responsibility to pay any and all tuition and fees due to Germanna Community College, minus anticipated VA payments made directly to the school, by the payment deadline or I may be dropped from my classes. The payment deadline for each semester is posted in multiple locations throughout campus and available on the Germanna website.
I understand that the VA does not pay “ACCESS fees” because they are considered online class materials/books. It is my responsibility to check with Germanna’s Business office to make sure all ACCESS balances are covered (either out-of-pocket or with Financial Aid) AFTER registering for classes. This must also be done when changes are made to my schedule (adding/dropping classes).
I understand monthly housing allowance benefits are paid based on rate of pursuit.
I understand if my benefit requires monthly enrollment verification, I am responsible for verifying I remained enrolled in the same courses or training every month.
I understand I must submit a new Registration Certification form to the GCC MVSC
at the beginning of every semester
. Benefits will be processed in the order in which received.
Statement of Understanding/Signature
I have read the information contained in this form, and accept responsibility for repayment to Germanna and/or VA if required. I understand the Terms and Conditions, and acknowledge that the information I have provided here is correct.
Student Signature
Date
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