I AM PLANNING TO ATTEND EL CAMINO COLLEGE IN:
SPRING SUMMER FALL WINTER YEAR: ________
PLEASE LIST ALL COLLEGES, INSTITUTIONS AND MILITARY SCHOOLS ATTENDED (IF NONE, WRITE “NONE”)
NAME OF SCHOOL LAST DATE ATTENDED
Please answer the following:
Military Status Self or Dependent
I am a Veteran
I am currently on Active Duty
I am a member of the Active Reserve
I am a member of the National Guard
Parent/Guardian is a Veteran
Parent/Guardian is on Active Duty
Parent/Guardian is on Active Reserve
Parent/Guardian is on the National Guard
Spouse is a Veteran
Spouse is on Active Duty
Spouse is on Active Reserve
Spouse is on National Guard
Branch of Service: ________________________
I AM REQUESTING TO RECEIVE EDUCATION BENEFITS UNDER:
CHAPTER 33
Post 9/11 GI BILL®
CHAPTER 33
Transfer of Benefits (Spouse/Child)
CHAPTER 33
Fry Scholarship (Spouse/Child)
CHAPTER 31 Vocational Rehabilitation and Employment Program
CHAPTER 1606
Montgomery GI BILL ® Selected Reserve
CHAPTER 30 Montgomery GI BILL®
CHAPTER 35
Dependents Educational Assistance Program (DEA)
GI Bill® is a registered trademark of the U.S. Department of Veterans Affairs (VA). More information about
education benefits offered by VA is available at the official U.S. government website at
www.benefits.va.gov/gibill
→ I request that El Camino College Veterans Services submit the appropriate forms to the VA so I may receive my VA Education
Benefits. I also give El Camino College Veterans Services permission to notify the VA of any changes in my unit status or
withdrawal from school and to furnish other information requested by the VA.
→ I understand that I am responsible for notifying the El Camino College Veterans Services of any changes in my class schedule or
attendance.
→ For Chapter 33 Post 9/11 GI BILL® recipients; I am responsible for all debts resulting from reductions or terminations of my
enrollment, even if the payment was submitted directly to the school on my behalf, and that the VA will not pay for courses I
did not attend, courses from which I withdraw, or courses I completed but received a grade which will not count towards my
graduation.
→ I realize that I may lose my VA Education Benefits if my GPA falls below 2.00 for two consecutive semesters or more.
__
________________________________________________________________ ________________________
Student’s Signature Date
_______________________________________________________________________________________________________________
Veterans Services Program Students Services Center Room 140 Office Hours: Mon-Thursdays, 9am-4pm. Fridays by Appointment only 310-660-3486
Rev. 10/2019
REQUEST FOR CERTIFICATION OF VA EDUCATION BENEFITS
NAME: STUDENT’S ID:
SSN: FILE # For Chapter 35 (DEA Program) only:
PHONE: E-MAIL:
click to sign
signature
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