Fillable Cash Check Charge Financial Aid Other Refer to (Rappahannock Community College)

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Cash Check Charge Financial Aid Other Refer to (Rappahannock Community College)

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Rev. 11/4/14
Rappahannock Community College
Certification Request for VA Education Benefits
General
Name (First, Middle Initial, Last)
Student ID
SSN
Street Address
Phone
City / State / Zip
Tuition Rate
IN-STATE
OUT-OF-STATE
E-mail Address
Now on Active Duty:
YES
NO
If “YES”, Separation Date:
Reservist / National Guard:
YES
NO
If “YES” to Active Duty and TA
Refer to Units Education Officer
Have you paid your tuition for the semester for which you are requesting certification?
YES
NO
I
f “NO” how do you intend on paying?
Cash Check Charge Financial Aid Other
VA pays the tuition for students receiving:
Chapter 31 (Voc. Rehab)
Chapter 33 at 100% eligibility
VMSDEP
Benefits
Have you ever received VA educational benefits at RCC or any other education institution? YES NO
Have you used your VA educational benefits at RCC within the last three years? YES NO
If “NO”
If it’s your first time using VA educational benefits, provide Certificate of Eligibility listing RCC or complete form 1990 or 5490.
If you have received VA educational benefits while attending another school, complete form 1995 or 5495.
Chapter 30 (MGIB)
Chapter 1606 (Reserve/Guard)
Chapter 1607 (REAP)
VMSDEP
Chapter 33 (Post 9/11)
Chapter 31 (Voc. Rehab)
# of dependents:
Chapter 35 (Dependents / Spouse Benefits)
VA File Number:
Chapter 33 (Transfer of Eligibility)
Advanced Pay (Chapter 30, 35 and 1606)
You may be eligible to receive your first two months of benefits prior to the start of the semester if you can answer “YES” to the next three statements:
YES NO
I have never used VA educational or there are more than 30 days between terms and break pay won’t be paid.
YES NO
I am enrolling for at least ½ time training. (The number of required credits depends on the number of weeks in the semester.)
YES NO
The VA will receive my request between 30 – 120 days prior to the enrollment period.
If eligible, do you request advanced pay?
YES NO
If “YES”, Complete form 1999 and sign the Advanced Pay – Terms and Conditions Form.
Program of Study
Associate of Arts (AA)
Associate of Science (AS)
Associate of Applies Science (AAS)
Non-matriculated (two terms only)
Certificate
Diploma
Supplemental Student
Major:
Must match Academic Plan on file with RCC
Is this a change of Program of Study since you last received VA educational benefits?YES NO
If “YES” Complete form 1995 or 5495
List of Courses
Are you graduating or completing a certificate program after this
semester? YES NO
You can be certified for non-essential courses only during the last
semester prior to graduation or completion of a certificate program
FALL SPRING SUMMER
2020 2021 2022
Department Number Section
D – Dev
C – Credit
# of
Credits
Dates
To be completed by Academic Advisor
ENG
111
01H
C
3
1/11/14 – 5/10/14
Requirement
(yes or no)
Initials
Date
Notes
Classes added after initial certification for this semester
Notes:
Rev. 11/4/14
Rappahannock Community College
Statement of Understanding
Please initial after each statement verifying that you understand the terms and conditions.
Application:
All first time students must complete an application. Students can submit applications online at
http://vabenefits.vba.va.gov/vonapp/main.asp. If a student does not apply online, they can call 1-888-442-4551 and ask that an
application be mailed to them.
Transfer or Change of Major
Student transferring or changing major must complete the proper Change of Program or Place of Training.
Schedule Adjustments:
You must immediately inform all changes in enrollment (i.e. add/drops) to the Rappahannock Community College Veteran Affairs
Office. Changes in enrollment after the last day of enrollment may result in retroactive loss in benefits unless the Veterans’ Affairs finds
mitigating circumstance involving the change.
Grades of Withdrawal must be submitted within 10 business days. All grades of a “W” will be retroactively reported to the Veterans’
Affairs and may result in a retroactive loss of benefits unless the Veterans’ Affairs finds mitigating circumstances.
Rappahannock Community College’s Academic Counseling is not responsible for changes in enrollment made after the initial date of
verification of courses by the advisor seen.
Rappahannock Community College is not responsible for reduction of benefits or retroactive action due to you enrollment activity.
Payment:
Veterans’ Affairs payment is based on “pursuit of training” towards your program of study. You must be enrolled and successfully
complete you courses to be eligible for Veterans’ Affairs benefits.
Refunds are subject to Rappahannock Community College’s policy.
Approved Courses:
You must register for courses that are required for the educational objective you have selected. The Veterans’ Affairs will only pay for
courses that are part of an approved program.
The Veterans’ Affairs will not pay benefits for courses previously completed with a passing grade or those that credit have been awarded
for.
Upon enrollment, credits from prior training, to include DD-214 and prior college transcripts, must be reported or else benefits may be
interrupted.
Change of Address or Direct Deposit:
Address and direct deposit information must be kept current. The WAVE system can be utilized by Chapter 30, 1606, and 1607. All other
must contact the hotline at 1-877-838-2778 or at www.gibill.va.gov/wave.
eBenefits:
Students are encourages to register and utilize this account in order to
• Obtain information regarding education benefits
• Update direct deposit and personal information
• Download VA letters and documents
• View payment status
Verification of Enrollment
Student receiving Chapter 30, 1606 and 1607 must verify their enrollment starting on the last calendar day of the month of attendance.
This is best done online at www.gibill.va.gov/wave/index.do.: this can be done over the phone at 1-877-823-2378 if there is no change in
enrollment.
Student Signature
Date:
Rev. 11/4/14
Rappahannock Community College
Signature of Recipient:
Date Received:
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Cash Check Charge Financial Aid Other Refer to (Rappahannock Community College)

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Completed 27 July 2020

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