VA Education Benefits Authorization Form
Email to
Last Name:
First Name:
Is this the first time
using benefits at
Yes No
900 Number:
Phone Number:
I understand the classes I enroll for the above term must be required for the major listed in
Banner to be reported for educational benefits. If I withdraw from classes at any time during
the semester I may create a debt to the Veterans Administration or Albany State. This form is
required by the Office of Military and Adult Education every semester in order to receive
Department of Veterans Affairs Educational Benefits. I understand the failure to turn this sheet
in, to provide truthful information, or to properly complete this form in a timely manner will
result in the delay of my Certification of Enrollment.
_____________________________ ______________
Student’s Signature Date
click to sign
click to edit