LaGuardia Community College
VETERANS REQUEST FOR CERTIFICATION
*PLEASE SUBMIT TO C-371 IF YOU ARE USING GI BILL BENEFITS FOR THE TERM BELOW*
Failure to complete any portion of this form may result in your certification not being processed.
NAME: STUDENT ID:
ADDRESS:
CITY: STATE: ZIP:
PHONE NUMBER:
_ YES
NO If yes, are you: __ Active Duty __ Guard/Reserve
Are you currently serving in the military?
Is this a new address? YES NO
Have you updated your
address
in CUNYfirst? Yes
No
__ I have applied for Benefits via VONAPP
Please select GI Bill Benefits program:
__Chapter 33 Post 9/11 GI Bill __Chapter 1606 Selected Reserve/ National Guard
__Chapter 30 Montgomery GI Bill __Chapter 1607 Reserve Education Assistance Program (REAP)
__Chapter 35 Survivors’ and Dependents’ Assistance __ I have recently changed from one benefits program to another
__Chapter 31 Vocational Rehabilitation
Are you planning to use Military Tuition Assistance?
Federal Yes No
State Yes No
Degree: __Associate’s __Certificate __Non-degree
Major/ Program: __________________________
We cannot certify veterans without a progressive objective.
Is this the same major you had last term? Yes No
*Term Requested: __ Fall 15, Session I (09/08/15 12/17/15) __ Fall 15, Session II (01/04/16 02/25/16)
__ Spring 16, Session I (03/05/16 06/20/16) __ Spring 16, Session II (06/27/16 08/15/16)
Course Number (i.e. ENGL 112)
In-seat or Online?
Course Name (i.e. English Comp I)
Repeat Course?
INITIAL EACH LINE TO INDICATE THAT YOU READ & UNDERSTAND YOUR RESPONSIBILITIES
_____ I must complete a new Veterans Request for Certification form EACH Session that I wish to use GI Bill
benefits.
_____ I understand that ANY registration changes, enrolling in an unauthorized repeat, or enrolling in a course
not required to fulfill my stated educational objectives may change my eligibility for GI Bill Education benefits
and might create a debt with either LaGuardia C.C., the Department of Veterans Affairs, or both.
_____ I MUST notify the School Certifying Officer if I add, drop, withdraw or otherwise stop attending any of
my classes.
_____ It is my responsibility to promptly notify the School Certifying Officer of any registration changes.
_____ I understand that I must make satisfactory progress toward my educational goal and that the school will
repost changes in my enrollment status, lack of academic progress, and any other information requested to the
VA.
I certify that the above course(s) do apply to my declared degree program/ certificate program.
Signature:_______________________________________ Date:_________________
Evaluator:_______________________________________ Date:_________________
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