REQUEST FOR CERTIFICATION
ALL REQUIRED DOCUMENTS MUST BE SUBMITTED TOGETHER TO BE CERTIFIED.
Student Information
LAST NAME
FIRST NAME
MI
STUDENT ID
ADDRESS
Address Change
SSN
VA FILE NO (35 ONLY)
EMAIL
CITY
ZIP
PHONE
ALT. PHONE
Student status: Recertification Incoming Student Returning Student
Transfer Student from: _____________________________________________
If a transfer student, have you submitted a change of program or place of training form? yes no
For which term would like to be certified:
Fall 20____ Spring 20____ Summer I/Summer II 20____ May Mini 20____ Winter Mini 20____
Are you: Veteran Active Duty Dependent
VA chapter: 33 (Post 9/11-Veteran) ____% 33 (Post 9/11-Dependent) ____% 30 (MGIB) 1606 (Reserve)
1607 (REAP) 31 (Voc. Rehab) (35 Dependent) VRAP
If chapter 33, approximately how much eligibility time do you have remaining? ____ months ____ days
NOTE: A reduction in the VA tuition and fee payment may occur if benefits run out during the semester.
Are you using the following state benefits programs? Hazelwood Combat Exemption for Children of Military
Service Members Not using any state benefits Other ____________________________
Major/Program: ____________________ Degree Type: AAS AS AA AAT
Are you graduating this semester? Yes No
Have you changed majors since your last certification? Yes No
If yes, from ___________________ to ____________________.
If yes, have you submitted a change of program or place of training form? Yes No
All transcripts (college, university, and military) have been provided? Yes No N/A
Has admissions evaluated your DD-214 for KINE credit? Yes No N/A
Previously used VA educational benefits: Yes, at Lee College Yes, at ____________________ No
Have you filed a Free Application for Federal Student Aid (FAFSA)? Yes No
With my request to use GI benefits, I agree that: (Please initial next to each statement)
_____I understand that the courses that I am certifying for are in my current major and on my degree plan, except as noted, and that if I enroll
in courses not in my major; I will be responsible to the Department of Veterans’ Affairs for any overpayment.
_____I understand that I must be registered in order for Lee College to process my certification with the Department of Veterans’ Affairs.
_____I will notify the VETERANS CENTER at Lee College each time I register, drop, or resign.
_____I understand that I must at all times have a CURRENT degree plan of my major on file, and that I must fill out a Change of Program form
any time my major changes.
_____I am responsible for payment of all charges not paid by the VA or other veteran benefits.
STUDENT SIGNATURE:
DATE:
RETURN THIS FORM TO:
Lee College Veterans Center EMAIL: va@lee.edu
PO BOX 818 PHONE: (832) 556-4300
Baytown, TX 77522 FAX: (832) 556-4305