UC Veteran Services Merced
Veterans Enrollment Card
BERKELEY • DAVIS • IRVINE • LOS ANGELES • MERCED • RIVERSIDE • SAN DIEGO • SAN FRANCISCO
SANTA BARBARA • SANTA CRUZ
Name____________________________________________________ Student ID Number _____________________________
Last Name First Name Middle Initial
Social Security Number # _____________________ Date of Birth __________________ UCM Email ___________________
Fall 20____ Spring 20____ Summer 20____
How many units will you be enrolled in this term?___
___Sophomore ___Junior ___Senior
Which term are you requesting benefits? (select only one)
What is your current major? __________________________
What is your current class level? ___Undergraduate
What is your current class standing? ___Freshman
Is this your last term of study?
Have you waived UC SHIP health insurance? ___YES ___NO
Which benefit are you eligible to receive?
___Ch.30 Montgomery GI Bill ___Ch.1606 Montgomery GI Bill-Selected Reserves
___Ch.31 Vocational Rehabilitation
___Ch.35 Survivors & Dependents of Disabled Veterans ___Ch.33 Post 9/11 GI Bill (select one ___Veteran or ___ Dependent)
Instructions: Check the box to indicate that you have read, understand and agree to the following:
I understand that the Veteran Enrollment Card must be submitted each term I wish to receive benefits.
I understand that it is my responsibility to notify UC Merced’s Certifying Official of any changes in program
(major/minor), unit change, or course withdrawal.
I understand that educational benefits will be paid only for courses that are applicable towards my declared degree
I understand that the VA will not pay for courses that I receive credit by exam, withdraw from, receive a non-passing
grade based upon attendance, and receive a non-passing grade that is non-punitive.
I understand that I am responsible for all tuition and fees. In the event the VA does not pay my balance, it is my
responsibility to pay all balances owed.
I hereby authorize the release of information contained in my UC Merced Veterans’ educational file to the Veterans
Signature_____________________________________ Date _________________________________
Student Information (Please print)
Student Enrollment Verification
Statement of Understanding