Admissions & Records Office
11711 Sand Canyon Road
Yucaipa, CA. 92399-1799
P: (909) 389-3372 F: (909) 389-9141
Crafton Hills College
Request for VA Benefits
All Sections Must Be Completed
Fall Spring Summer 20
Please print all the information below carefully and clearly
Name Phone
Day Evening
Mailing Address City Zip
Last Four Digits of SSN CHC Student ID #
What is your major? Is this a new program? Yes No
Please List any and all colleges you have attended in the past:
Course Title # of Units
Total # Units
I Certify to the best of my knowledge the above information to be true and correct. I am not duplicating courses I have
successfully completed. I accept full responsibility in notifying the V.A. CERTIFYING OFFICIAL at CRAFTON
HILLS COLLEGE in the ADMISSIONS & RECORDS OFFICE of any changes to my enrollment effective the week
of such changes. I also authorize the release of my school and testing records to the V.A. for use in counseling and
supervising my program of education and training.
Signature Date
If you have completed one year or more of Continuous Active military service, you may not be certified for
Physical Education activity courses or Health Education Courses
General Work Experience courses cannot be certified under your Montgomery GI Bill.
This Office must have on file official transcripts of your previous college attendance before you register for your
second semester. Furthermore, an evaluation of your prior college credit must be completed before this office can
certify your enrollment.
If you are entering Crafton Hills College for the first time and have already earned a college degree or have
completed sixty or more units, you must meet with our Veterans Counselor before this office can certify your
It is your responsibility to notify this office as soon as your drop, add or change any course on your
schedule. Failure to do so could result in a denial of future requests.
I hereby certify that I have read and understand all of the information above.
Signature Date