MCC-164 An Equal Opportunity College/Affirmative Action Employer Rev. 05/15
Attendance Sheet for Recipients of Education Benefits from the Department of Veteran Affairs
Student’s Name
Reporting Dates for 2015-2016
This sheet is due to the Veteran’s Office by each reporting date
indicated below.
(Please check the appropriate reporting date being certified.)
Last First MI
Social Security #
Phone (If necessary
to contact you)
XXX-XX- ____ ____ ____ ____ Student ID# _______________________
September 4
September 25
October 16
November 6
November 27
January 29
February 19
March 11
April 1
April 22
June 10
July 1
July 22
List Course #, Course Name and Number of Credit Hours for each course.
Also list online courses.
Instructor Signature
Sign to certify this attendance/participation has been satisfactory
to date.*Instructors for online courses can e-mail Ann Saunders at
To Avoid Payment Problems
1. Please report any dropped
class(es)/withdrawals to
Mitchell’s Veteran’s Office
2. Turn in attendance sheets
by dates listed above.
3. Courses you enroll in must be
required for graduation as
stated in the curriculum outline
in the Mitchell Catalog.
4. You may not take a course for
payment for which transfer
credit has been granted.
5. If substituting a class, an
official substitution letter must
be on file in the Office of
Admissions and Records with
a copy sent to the Veteran’s
Course # Course Name
a. a.
b. b.
c. c.
d. d.
e. e.
f. f.
*If attendance/participation is NOT satisfactory, please explain.
I certif
that the information on this sheet is correct and com
Student’s Signature Date
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