2017-2018 VAC POA
Complete this form to ensure VA benefits will be certified for the 2017-2018 Academic Year at Franklin University. You
are responsible for notifying the Office of Military and Veterans Affairs team if you run out of benefits, intend to
change benefits, or do not want to be certified for a specific term.
Student Last Name Student First Name
Branch of Service in Military Franklin Student ID Date of Birth
1. Current Degree Goal: Associate Bachelor Masters Doctoral
Note: Certification is based on actual hours enrolled and actual VA Training Time. The amount of
educational benefit is determined by the number of credit hours and the length of training time in which
you are enrolled. Due to Franklin’s Balanced-Learning format, full-time enrollment (12 hours) at the
University does not necessarily reflect full-time payment for your Veteran’s Benefits. If your
enrollment hours or training times change, your benefit eligibility may be affected.
BREAK PAY: Break or interval pay is no longer payable under any VA educational benefit program.
2. Check the term(s) you want certified for this year: Summer 2017 Fall 2017 Winter 2018
Note: If attending school for the entire year, please check each box.
3. Type of VA Education Benefits: Chapter*: *If Chapter 33, % Payment Rate is:
*If Chapter 35, file number is:
4. Please indicate the approximate end date of your benefit: (mmddyy)
5. Have you previously used your VA benefits? …………………………………………………………… Yes No
If yes, please submit VA Form 22-1995
6. Have you previously used your VA benefits at Franklin? …………………………………………. Yes No
7. What is your current Military status? (Check all that apply)
Veteran Active Duty Reserves/Guard
8. In addition to Franklin (home school), are you attending another institution (host school) in order to transfer hours
toward your degree at Franklin? ……………………………………………………………………………… Yes No
If “yesyou must initiate a request for a Transient Letter through your academic advisor by
emailing omva@franklin.edu. The Transient Letter will confirm what courses at the host school
will transfer toward your degree at Franklin.
9. Are you planning to use any other funding? (Financial Aid, Employer Benefits, Tuition Assistance, etc…)
If so, please indicate here:
2017-2018 VAC POA
You must be a new student or a returning student who has been out of school for 30 days and be enrolled at least
halftime. Checks will be available for pick-up at the Otte Student Services Welcome Center, or may be mailed. An
Acknowledgement Letter MUST be signed when you receive your check. If the check is received by mail, you must sign
and return the Acknowledgement Letter. You will not receive another check until the end of the trimester’s third
calendar month.
Check this box only if you are requesting advance payment:
The VA will only pay for those courses required for your degree completion. It is your responsibility to see an
Academic Advisor concerning any questions you may have about your program or specific courses you plan to take.
Do not enroll in any audit, refresher, or repeat course, or declare a double major without consulting the Department
of Veteran Affairs. If “Z”, “NZ”, or “W” grades are received, hours will be reduced and the VA will be notified as of the
last day of attendance for the course.
By my signature below, I hereby agree to the following conditions:
If I am not eligible for the maximum eligibility, I must arrange payment no later than 30 days after the start of
the first class. It is my responsibility to make payment in accordance with the University’s tuition payment
If enrollment is terminated for any reason, the unpaid balance of tuition and fees is due immediately.
If I drop my class prior to the start date or I am dropped for non-attendance, I understand that any funds
received for tuition will be returned to the VA directly.
If I drop my classes any time on or after the start date, which creates a credit, I understand the funds will be
refunded to me and I am responsible for contacting the VA immediately to clear up any overpayment issues.
If I am using the National Guard Scholarship in conjunction with Post-9/11 GI Bill, it is not to exceed 100% of my
tuition. Franklin will apply the National Guard Scholarship first, then reduce Post- 9/11 GI Bill funds to cover the
remaining balance.
If I am using Federal Military Tuition Assistance in conjunction with Post- 9/11 GI Bill, it is not to exceed 100% of
my tuition. Franklin will apply any Federal Military Tuition Assistance first, then apply Post- 9/11 GI Bill funds to
cover and remaining balances.
If I am receiving any Financial Aid that is for tuition only in conjunction with Post- 9/11 GI Bill, it is not to exceed
100% of my tuition. Franklin will apply any tuition-only Financial Aid, then apply Post- 9/11 GI Bill funds to cover
any remaining balance.
I acknowledge and accept responsibility for all debts owed to Franklin University under the terms and conditions
stated herein, and agree my signature below is evidence I have read, understood, and agree to the terms and
conditions stated herein and have received a copy of the agreement.
Student Signature:
Return documents to: Franklin University
Office of Military and Veterans Affairs
201 South Grant Avenue
Columbus, OH 43215
Fax: (614) 255-9514
Email: OMVA@franklin.edu
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