12/2015
Office of Student Records
1 University Drive UPO 789
Campbellsville, KY 42718
Phone 270.789.5151 Fax 270.789.5362
twlawson@campbellsville.edu or jbclark@campbellsville.edu
VETERAN’S EDUCATION BENEFITS TRACKING FORM
Today’s Date:________________ Semester to begin coursework:___________________________
Full Name of Student:_______________________________________________________________
Were benefits transferred to you? NO YES, from:_______________________ __________
VA Chapter:
Birthdate:_______________ SSN:__________________ CU Student ID #:_________________
Phone #: Primary _________________ Secondary _________________
I acknowledge that I am responsible for notifying the Office of Student Records of any change in my
course schedule, program (major/minor), or contact information.
Signature:__________________________________________________ Date:________________
name relation
E-mail Address:____________________________________________________________________
Home Address:____________________________________________________________________
__________________________________________________________________________
CH 33 - Post 9/11 GI Bill
CH 30 - Montgomery GI Bill
CH 31 - Vocational Rehabilitation
CH 35 - Survivors & Dependents VA File #:_______________ Payee #:______
CH 1606 - Montgomery GI Bill Selected Reserves
CH 1607 - Reserve Educational Assistance Program
________________________________________________________________________________
CAMPBELLSVILLE UNIVERSITY
Have you used benefits in the past? NO YES, at:__________________________________
school name
Colleges attended:_________________________________________________________________
Degree seeking:
Area/Major:__________________________________________
Minor:__________________________________________
click to sign
signature
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