~Columbia
~
Basin College
Veterans Services
YELLOW RIBBON FUNDS REQUEST
2020-2021
Student Name:__________________________________________ Student ID #:_____________________
State of Residence:______________________________________
Year/Quarter Requesting Assistance:____________________
__________________________________________________________
Signature of Student
________________________________
Date
TO BE COMPLETED BY SCHOOL VA CERTIFYING OFFICIAL:
Student receiving Post-9/11 GI Bill benefits: Yes No
100% eligibility under Post-9/11 benefits: Yes No
Student being charged out-of-state Tuition/Fees: Yes No
Total out-of-state charges to be covered by YR funds: $________________
50% match amount to be paid by CBC: $________________
Student qualifies for YR funds based on eligibility & funding available: Yes No
___________________________________________ _________________________
Date Signature of VA Certifying Official
Return this request to:
Columbia Basin College
Daniel Osorio, VA Certifying Official
2600 N 20
th
Ave, Pasco WA, 99301
(509)-542-4880 | FAX (509)-544-2021
Email: veterans@columbiabasin.edu
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