REQUEST FOR CERTIFICATION
ALL REQUIRED DOCUMENTS MUST BE SUBMITTED TOGETHER TO BE CERTIFIED.
☐
VA FILE NO (35 ONLY)
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.
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
