OFFICE OF VETERANS AFFAIRS
Student Name Social Security Number
Primary Phone MTC Student ID
Primary Email Address
I CERTIFY THE FOLLOWING
› I understand that in order to receive benefits for a specified term, I must notify MTC’s VA Office that I have
registered for classes each semester. (Initial)
› I am responsible for notifying the MTC VA Office of any changes in my enrollment status. (Initial)
› Courses not required for my program of study will not be approved for payment of VA benefits.
› I may owe MTC or the VA money for course failures, withdrawals and no-shows. If you repeat a failed class and fail it
a second time, the grade will be non-punitive. You will be required to repay the VA funds received for that course.
› If you no-show a course (register, do not attend, do not officially withdraw), the VA will not pay for the course. You
will be charged full tuition and fees for the no-showed course. (Initial)
› I am only able to receive VA benefits for ONE (1) semester if I am pending a transcript from another institution.
(Initial) (answer N/A if no prior college attendance)
I have read the conditions of the MTC VA Student Contract and agree to be held responsible as set forth above.
Student Signature Date
MIDLANDSTECH.EDU | PO BOX 2408 | COLUMBIA SC 29202 | 803.738.7615
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