VETERAN’S INFORMATION SHEET
Title IX Coordinator: Lolita Morrison, Director Human Resources, Georgia Piedmont Technical College, 495 North Indian
Creek Drive, Clarkston, GA 30021, Rm 157A, morrisonl@gptc.edu, 404 297-9522, Ext. 1210
Equal Employment Opportunity (EEO) Compliance Officer: Lolita Morrison, Director Human Resources, Georgia Piedmont Technical
College, 495 North Indian
Creek Drive, Clarkston, GA 30021, Rm 157A, morrisonl@gptc.edu, 404 297-9522, Ext. 1210
ADA/504 Coordinator: Dr. Perrin Alford, Vice President for Student Affairs, Georgia Piedmont Technical College, 495 North Indian Creek
Drive, Clarkston, GA 30021, Rm 217, alfordp@gptc.edu, 404 297-9522, Ext. 1231
Office of Student Financial Services & Veteran Affairs
495 North Indian Creek Dr., Clarkston, GA 30021
PHONE: (404)297-9522, ext. 1111, FAX: (404) 294-6290
www.gptc.edu
Last Name First Name M.I Student Number
Address City State Zip Code
Phone Number E-mail Address
Please Circle: Degree Diploma Certificate
Program of Study/Major
New Student Continuing Student Transfer Student Transient Student
Chapter 33 (Post 9/11) Chapter 31 (Vocational Rehabilitation)
*Please provide Certificate of Eligibility VA Counselor:______________________________
*If used benefits before complete VA-Form 22-1995 *Certification will not be processed until the VA Certifying Official
receives authorization (VA Form 1905) from your VA Counselor.
Chapter 30 MGIB Chapter 35: (Dependent Spouse or Child)
* Please provide Certificate of Eligibility –or- *If used benefits before please complete VA Form 22-5495.
* If used benefits before complete VA Form 22-1995 *VA File Number:________________________ Payee#_________
Chapter 1607 (REAP) Chapter 1606 (Reservist)
*Please provide NOBE (Notice of Basic Eligibility) if available.
Please indicate the term you are requesting certification for by circling one of the following:
FALL SPRING SUMMER Indicate the year here:____________ Total Hours Enrolled this term: ________
*Please note, according to VA Regulations courses that are not listed as a requirement for your Program of Study and do
not count towards graduation are not eligible to be certified. For more information please visit www.gibill.va.gov
*It is your responsibility to notify the school’s VA certifying official of any changes made to your enrollment during the
semester. Failure to do so may adversely affect your MGIB Benefits.
Student Signature_____________________________________________ Date:___________________________________
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