CLOUD.EDU/STUDENTS/VETERANSERVICES
VA STUDENT CHECKLIST
Cloud County Community College
Concordia Campus / Geary County Campus / Online
Phone: 1-800-729-5101
Email: veterans@cloud.edu
Please fill this out and return to your campus VA School Certifying Official.
Full Name:
Student ID:
Last
First
M.I.
Address:
Street Address
Apartment/Unit #
City
State
SSN.:
___ ___ ___ - ___ ___ - ___ ___ ___ ___
Phone:
Email
Semester to
begin benefit
(circle term):
FALL SPRING SUMMER
Year:
CH35 VA
File #:
___ ___ ___
- ___ ___ - ___ ___ ___ ___
Leave this blank if not applicable.
Check the box of your VA education benefit below:
Post-9/11 (Ch. 33) ____ %
Post-9/11 T.O.E. (Ch. 33 for Dependent/Spouse) ____ %
Montgomery GI Bill (Ch. 30)
National Guard/Reserve (Ch. 1606)
Survivors and Dependents Educational Assistance-DEA (Ch. 35)
Vocational Rehab (Ch. 31)
Have you applied for your GI BILL? YES NO
If NO, please file a VA Form 22-1990 (All chapters but CH-35) or 22-5490 (CH-35 only)
If YES, please submit your Certificate of Eligibility to your campus SCO.
Have you used your GI BILL with another college? YES NO
If NO
, skip question 3.
If YES, please file a VA Form 22-1995 (All chapters but CH-35) or 22-5495 (CH-35 only)
If Cloud is NOT your Primary Institution and you are using a Parent Letter, please list your Primary Institution:
Institution:________________________________________________________________________
City, State, Zip: ________________________________________________
Are you currently on active duty? YES NO
CLOUD.EDU/STUDENTS/VETERANSERVICES
PAYMENT ARRANGEMENTS MUST BE MADE WITH OUR BUSINESS OFFICE PRIOR TO THE
BEGINNING OF EACH SEMESTER FOR ANY BALANCE OF BOOKS, TUITION OR FEES NOT PAID
DIRECTLY TO THE COLLEGE BY THE VA
CHAPTER 33 POST 9/11 GI BILLVETERANS EDUCATIONAL ASSISTANCE ACT OF 2008
Based on your length of active duty service your Certificate of Eligibility (COE) states at what percent you are
rated. Tuition and fees are submitted to the VA after the 20
th
class day, and that percentage will be paid directly to
the college.
It is your responsibility to pay any remaining percentage that is not covered by the VA in addition to text books.
Any Book Stipend money and Basic Housing Allowance you are entitled to will be paid directly to you.
CHAPTER 30 MONTGOMERY GI BILLACTIVE DUTY EDUCATIONAL ASSISTANCE PROGRAM
Benefit payments are made directly to you and it is your responsibility to pay the college for tuition, fees and
books. Enrollment must be verified at the end of each month through WAVE at https://www.gibill.va.gov/wave/ or
by calling IVR at 1-877-823-2378 in order to receive your payment.
CHAPTER 35 SURVIVORS’ AND DEPENDENTS’ EDUCATIONAL ASSISTANCE PROGRAM- DEA
Due to a parent/spouse being listed with the VA as 100% disabled or deceased the benefit payments are made
directly to you the first part of the month; and you are responsible to pay the college for tuition, fees and books.
CHAPTER 31 VOCATIONAL REHABILITATION AND EMPLOYMENT VR&E
Through this program you will receive notifications from your VR&E Counselor and payments for tuition, fees and
books will be made directly to the college through 3rd party billing.
CHAPTER 1606 MONTGOMERY GI BILL SELECTED RESERVE/NATIONAL GUARD
Benefit payments are made directly to you and it is your responsibility to pay the college for tuition, fees and
books.
*NOTE: The VA will not fund any online developmental course and/or any section of SS 099
Personal Assessment. A developmental course is defined as a course below 100 level.
-------------------------------------------------------------------------------------------------------------------------------------------------------------------------------
IT IS YOUR RESPONSIBILITY:
To notify the SCO of any drops, adds or total withdraws to the current schedule.
To notify the SCO of any change that would affect the payment rate or program of study. (i.e. Major)
To follow the degree program outlined in the CCCC catalog.
(https://www.cloud.edu/Academics/Catalog/index
)
To understand how training time and credit hours may affect VA payment rates based on your chapter.
To be sure any repeated courses qualify for benefit payment.
To make sure classes meet VA certification requirements in order to receive payment.
To attend all classes regularly, and make satisfactory academic progress.
To pay the college for any unpaid debt not covered by the VA.
I am signing this because I have read and understand the above information; and that I will be
responsible for any unpaid debt incurred on my student account at CCCC.
STUDENT SIGNATURE DATE
Please turn in any VA documentation to the following school certifying officials:
CONCORDIA CAMPUS GEARY COUNTY CAMPUS
VA Facility Code: 14933116 VA Facility Code: 14934116
2221 Campus Dr. 631 Caroline Ave
Concordia, KS 66901 Junction City, KS 66441
Contact: Patti Elliott Contact: Steph Pitchford
pelliott@cloud.edu spitchford@cloud.edu
EXT. 207 EXT. 714
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