California State University, Chico
Office of Veterans’ Affairs
REQUEST FOR BENEFITS
Name _______________________________________________________ Student ID # _____________________
YOUR CURRENT ADDRESS: If Change of Address, Check Here:
Street _______________________________________________________________________________________
City ______________________________ State ____ Zip ____________ Phone ____________________________
Wildcat Email: _________________________________________________ @mail.csuchico.edu
• You must submit your request using your Wildcat Email to: VA@csuchico.edu.
• Macintosh Computers and Internet Browsers other than Explorer may have a conflict with this form.
• Use a PC, complete and save the form to your desktop, then send the completed form to us.
Current Objective:
BA/BS 2
nd
BA/BS MA/MS Teaching Cred.
Class Level: Fr
So Jr Sr Post-Bacc Expected Graduation Term: _________________
Major: ____________________________________________________ If Change of Major, Check Here:
IMPORTANT NOTICE: Certification beyond this semester is NOT automatic. It is your responsibility to ensure
that your benefits continue. Allow VA 4-6 weeks to process any claim.
I understand that I will only receive benefits for courses that are required to complete my approved
academic program. I agree that I will notify the Office of Veterans’ Affairs of any and all changes to my class
schedule within one week of the change or I may experience payment delays. Submitting this request with
my Wildcat Email constitutes my signed agreement with the information as listed on this request and is
considered appropriate for processing my request.
This request is for _________ units for the ________________________ semester.
(maximum is 12) (ex. 2018 fall or 2019 spring)
I plan to attend another college concurrently: What school? _______________________________________
Classes at other school must fulfill requirements for CSUC program: Number of units at other college __________
Note: You are responsible for contacting the other school about receiving benefits for those classes.
