LOUISIANA TECH UNIVERSITY - BARKSDALE
VA Enrollment Certification
Michael Solice ▪ BAFB VA Liaison Counselor ▪ msolice@latech.edu ▪ 318-456-5006
Revised 8/8/2018
Personal Information
SS #
Last Name First Name M.I.
Mailing Address - (Street, Apt.) City/State Zip Code
E-mail Address ___________________________________ Phone #
Enrollment Information
Major ________________________________________ Graduating this quarter? □ Yes or □ No
This certification is for: □ Fall □ Winter □ Spring □ Summer Year
List below all courses enrolled in for this quarter that are counting toward your degree program/major.
Total hours for the quarter
Chapter of Benefits
I am requesting benefits for the following:
□ Chapter 1606: MGIB - National Guard/Selected Reserve
□ Chapter 30:
MGIB (Active Duty)
□ Chapter 31: VA Vocational Rehabilitation
□ Chapter 33: Post 9/11 GI Bill □ Dependent or □ Veteran
□ Chapter 35: Survivors and Dependents Benefit
Are you using National Guard Tuition Exemption this quarter? □ Yes or □ No
NGTE is handled through the Cashier’s Office. Please contact cashier at 318-257-4325 to apply your NGTE
Important Information Regarding your VA Education Benefit
• VA will only pay for courses required for your degree.
• Dropping courses that put you below full-time will create a debt with the VA.
• This form should be filled out and turned into the VA Certifying Official each quarter that you choose to use your
benefits. If you plan to change your schedule, please wait to turn in this form until you have made the changes.
• Graduating seniors can register for any selection of courses they are eligible for during their graduating quarter
and the VA will pay. This is only during the graduating quarter.
• VA will not pay for courses that are not required for repeat.
• Failure to turn in this form each quarter will delay your benefits.
Signature Date
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signature
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