CISCO COLLEGE VA INFORMATION SHEET
NAME:____________________________ SS#_____________________________________
DATE OF BIRTH ____________ PHONE#______________ VA FILE# (CH 35 DEP ONLY)______________
DA
TE OF DISCHARGE FROM SERVICE ______________ BRANCH OF SERVICE_____________
BENEFIT: __MONTGOMER GI BILL (CH 30) __GUARD/RESERVE (CH 1606) __POST 911 (CH 33) __
POST 9/11 (CH 33 DEP) __ DEPENDENT (CH 35) __ACTIVE DUTY (CURRENT) __VEAP (CH 32) __ REAP
(CH 1607) __CH 31 __VRAP
MAILING ADDRESS:_____________________________________________________________
In order to avoid mailing and/or payment problems. It will be your responsibility to keep the VA and Cisco Veteran Services Specialist informed
of your address and phone number.
Email Address: ______________________________________________________________
DESIRED DEGREE: ASSOCIATE IN ARTS____________________________________________________
ASSOCIATE IN APPLIED SCIENCE__________________________________________________________
CERTIFICAT PROGRAM____________________________________________________________________
You will only be certified to the VA for courses listed on your degree plan. A degree plan must be in your file before your hours will be certified
to the VA (Contact a Cisco Counselor to obtain your degree plan)
__I request a change in place of training from (list prior school)______________________
Please list last date
attended prior school under GI Bill ______________
You must list all colleges attended and provide the veterans coordinator with the transcripts, regardless of credit
earned. This information is required by the Dept. of Veterans Affairs and must be reported.
1.___________________________________ 2._______________________________________
3.___________________________________ 4._______________________________________
All transcripts must be evaluated by a counselor and a degree plan provided to the Veterans Coordinator. VA requires all previous credit be sent
to them for all previous college work.
___ I AM REQUESTING A CHANGE OF PROGRAM NEW PROGRAM:_______________________
STATEMENT OF UNDERSTANDING-PLEASE READ AND SIGN BELOW
1. Each term I must report my registration and any changes in my enrollment to Cisco Veteran Coordinator.
2. I must be enrolled in an approved program of study that leads to a standard college degree and have all prior training
evaluated by a counselor by the endo of my second quarter of enrollment. I do not expect to be paid by the VA for classes
previously passed.
3. I will ensure the classes I am taking are required in my program. I understand that I must make satisfactory progress toward
graduation
4. I understand that grades of W, I or F may result in a reduced payment from the VA.
5. Courses for which an “I” (incomplete) is awarded must be completed by the end of the subsequent quarter (excluding
summer).
6. I understand that classes scheduled to meet for less than the normal quarter term dates may be paid at a different rate based on
the number of credits and the length of the class
7. I understand that payment for developmental (remedial/deficiency) classes will not be allowed unless need for such class (s) is
established by a placement test and/or documented by a counselor.
8. I understand that the VA will hold me responsible for any overpayment of my educational benefits.
