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.
(ex. ENGL 101)
( if online)
(ex. ENGL 101)
( if online)
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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