Change to VA Certification
____________________________________ _____________________ _______________________
Name VA File Number Student ID #
_______________________________________________________________ _______________________
Street Address Home Phone
_______________________________________________________________ _______________________
City/State/Zip Work Phone
Under which program do you qualify for VA Educational Benefits?
Chapter 30 (Montgomery GI Bill) Chapter 31 (Voc Rehab)
Chapter 32 (VEAP) Chapter 35 (Dependent)
Chapter 1606 (Guard/Reserve) Chapter 33 (Post-9/11)
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DEPT
COURSE
NUMBER
CREDIT
HOURS
COURSE TITLE
IS THIS A
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COURSE
Drop
DEPT
COURSE
NUMBER
CREDIT
HOURS
COURSE TITLE
IS THIS A
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COURSE
________ Number of hours originally enrolled at CCC.
________ Number of hours enrolled after changes.
Degree: ___________________________________________________________________________________
Major: ____________________________________________________________________________________
Any changes to your approved schedule may affect your status with the Department of Veteran Affairs and your
VA benefits. Changing to classes that do not apply to your degree plan may result in a loss of benefits. Please
consult an Academic Advisor for confirmation that any class changes fit your degree plan.
________________________________________________________________________ _________________
Student’s Signature Date
________________________________________________________________________ _________________
Approved Signature Date
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