Pearl River Community College offers equal education and employment opportunities. The College does not discriminate on the basis of race, religion, color, sex, sexual
orientation, gender identity, age, national origin, veteran status, or disability. For inquiries regarding the non-discrimination policies or to request accommodations,
special assistance, or alternate format publication please contact Tonia Moody Seal, Director of Admissions and Records, and ADA/Civil Rights Coordinator, at P.O.
Box 5537, Poplarville, MS 39470 or 601-403-1060. For inquiries regarding Title IX, contact Maghan James, Assistant Vice President of Student Services and Title IX
Coordinator, P.O. Box 5560, Poplarville, MS 39470 or 601-403-1253.
VA Education Benefits Information
Have you used VA Education Benefits before?
Benefit do you
plan to use at
□ Chapter 30 – Montgomery GI Bill
□ Chapter 31 – Vocational Rehabilitation
□ Chapter 33 – Post 9/11
□ Chapter 35 – DEA – Dependents’ Educational Assistance
□ Chapter 1606 – Montgomery GI Bill Selected Reserves or National Guard
□ Chapter 1607 – REAP – Activated Reserves or Nat’l Guard under Title 10 Contingency Operations
Required Field for Chapter 35 ONLY:
VA File Number:__________________________
Are you a
□ Yes, my branch of Service is/was:
Check all that apply:
□ Air Force
□ Coast Guard
□ National Guard/Reserves
Are you currently active duty?
If yes, what is your scheduled separation date?
Read and initial each item:
□ It is my responsibility to complete a "Request for VA Certification" form for every semester that I wish
to use my VA Education Benefits at PRCC.
□ The VA will only pay for classes that pertain to my designated degree, and if I wish to change my major,
I will notify the VA Certifying Official before I do so.
□ Certification cannot be completed on Remedial or Developmental Courses taken online.
□ It is my responsibility to make sure that my balance is paid in full every semester.
□ If I change my schedule - withdraw, add, drop, etc. - I must contact the VA Certifying Official
immediately. Failure to do so may result in an overpayment that I may be responsible for paying back.
By signing this form, I attest that I have read and understand the statements above. I also understand that
all communication will be made via my PRCC Student Email account.
click to sign
click to edit