Revised 8/19/2019 crp
`
GRAMBLING STATE UNIVERSITY
VA SEMESTER BENEFITS FORM
Full Name Student ID # Social Security #
Address City State Zip Code
Telephone # Email Address Major
VA INFORMATION (PLEASE CHECK THE APPROPRIATE BOXES)
What semester are you applying for benefits? __Fall __Spring __Summer I __Summer II Year 20___
GI Bill Used: __Montgomery GI Bill Active Duty (Chapter 30) __Montgomery GI Bill Reserve/Guard (Chapter 1606)
__Activated Reservist (Chapter 1607) __DEA(Chapter 35) __Post 9/11 GI Bill Transfer of Entitlement
__Post 9/11 GI Bill
Enrollment must be verified at the end of every month by Chapters 30, 1606, and 1607 participants by calling 877-823-2378 or
logging into either www.ebenefits.va.gov.
All State Aid Exemptions (Title 29, ARNG, etc.) are processed in the Office of Financial Aid (318-274-6328 or 6439).
Student Status: __Used benefits at GSU last semester or a previous semester __Never used benefits before
__Transfer (used benefits at______________________________________________________________)
__Visiting student (Primary School _________________________________________________________)
I understand that this form must be filled out and verified by my academic advisor every semester that I intend on using
benefits.
Education benefits can be affected by schedule adjustment. I agree to notify the School Certifying Official of any
adjustments to my schedule (adds, drops, withdrawals). I agree to update my semester benefits form if there are any
changes to my schedule.
I understand that I am responsible for any overpayment received from the VA.
I understand that VA does not pay for classes that will not be applied toward my degree. I also understand that classes I
have previously earned credit either at GSU or from another school will not be certified with the VA.
I understand that I must maintain satisfactory academic progress as detailed in the GSU course catalog.
I understand that it is my responsibility to notify the School Certifying Official of any change in my VA eligibility.
I HAVE READ AND UNDERSTAND THE INFORMATION ABOVE
Signature_________________________________________________ Date____________________________________
Comment (Remedial or Repeated Course)
Are you in Clinical Rotations, Internships, or Externships?
I certify to the best of my knowledge that the classes listed above are required for completion of the student’s program of study.
Academic Department Head’s Signature:__________________________________________ Date:_______________________
click to sign
signature
click to edit
![]()
click to sign
signature
click to edit
![]()
