Louisiana College Financial Aid Office
Tel: (318)487-7386 Fax: (318)487-7449
1140 College Drive
Pineville, LA 71360
VETERANS’ CERTIFICATION DATA FORM
Fall
20___
Spring
20___
Summer
20___
NAME:
ADDRESS: ________________
STATE: _
ZIP CODE:
__________
SSN:
Student lD#:
Major/Degree Plan:
Graduation Year:
TELEPHONE (Cell) : - - EMAIL: _____________________________________________________
___ New Student: When and how was your application submitted? ___
VONAPP (online) Date:___________________
___Transfer Student: Request an official transcript from your previous institution(s) and complete Change of Training Place FORM #22-
1995.
(
Unable to certify student’s enrollment without this form.)
Visiting StudentPrimary Institution: (Submit a letter from your primary institution
stating that the credit(s) that you plan to take at LC will be accepted toward your degree.)
___ Returning StudentLast term attended at LC:
CLASSIFICATION: ___FR ___SO ___JR
___SR ___GRAD
Do you have a degree? ___ NO ___YES If yes, ___2 yr or ___4 yr
VA ELIGIBILITY: ___Ch 30 (Montgomery GI Bill) ___Ch 31 (VA Voc Rehab) ___Ch 32 (VEAP)
___Ch 33 (Post 9/11 GI
Bill) ___Ch 35 (Dependent of Vet**) ___Ch 1606 (Reserves/Guard) ___TA Tuition Assistance
(Go Army Ed)
**Note to Chapter 35 Student, please provide following information:
Name of VA Parent/Spouse:
Phone #
SS #
VA File #
___Are you VA Work-Study? If so, you will need to coordinate job with VA Certifying Official at LC. Application for Work-Study Allowance
available in Financial Aid Office or http://www.vba.va.gov/pubs/forms/VBA-22-8691-ARE.pdf
NOTE TO:
1. All VA Students
2. New Student or Never Used VA Benefits
Before
3. Transfer Student
-
Used
VA
Benefits Before
1.
Complete and submit this VA Data Form each semester with your
advisors signature.
2.
Indicate any course repeats and tell why (include W and F grades.)
3.
All students except for Chapter 31, 33 & 35, need to verify
hours at
the end of each month at http://www.qibill.va.Nov/resources/verify
attendance/index.html or call 1-888-442-4551
4.
Register early to avoid delay in benefits.
6. All Post 9/11 students must submit a copy of Certificate of Eligibility
If you have never used your benefits:
1.
Complete and submit Form 22-1990 at
http://www.qibiIl va.gov/apply-for-benefits/
2.
Complete and submit this VA Data Form each
semester with advisor’s signature.
1.
Used benefits before: complete and
submit VA Form 22-1995.
http://www.vba.va.oov/pubs/forms/VBA-
22-1995-ARE.pdf
2.
Complete and submit this VA Data
Form each semester with advisors
signature.
Current semester courses: Please list your courses for this semester in the table below.
All hours pursued must apply toward your
Degree Program or
be a required prerequisite to a course in your Degree Program.
All courses added, dropped or
audited must be reported to the LC Financial Aid Office
immediately. Please note that VA will not pay for Audited Courses, courses that do not
fulfill graduation and repeated courses that have been successfully completed.
COURSE NAME & #
REPEAT?
YES
NO
HOURS
COURSE NAME & #
HOURS
Off-Campus Training: Name______________________________Address(include zip code)_____________
________________________________________________________________________________________
Any repeats, explain why:
________________________________________________________________________
Please note that payment may be received 4-12 weeks after certification is received by the Veterans’
Regional Office
.
ALL
course(s) listed above lead to my degree. I understand that only F" grades or courses that must be completed with a certain grade or grade
point
average can be repeated. I hereby authorize VA Certifying Official to release information to the Veterans’ Administration concerning my status, as a
VA
student at LC.
I will immediately notify the Certifying Official of all changes that occur in my enrollment.
I understand that failure to do
so
may result in a delay of benefit payment or an over-payment with VA. I also understand that if I choose to stop attending my classes, VA will be
notified,
and this may also cause an over-payment with VA.
Veterans Affairs Office: 1-888-442-4551 or www.qibill.va.qov to check status of benefits, to print form/application or if you have questions. VA will
email notification when enrollment is certified.. Make sure
that the courses listed above match your schedule. Also, complete this form if at any
time you add a class or drop a class and attach
a copy of your schedule. If this form is incomplete, this will cause a delay in certification.
I have read and understand the above and will check my email for updates and information.
STUDENT SIGNATURE - must be physical signature not typed DATE
Please return this completed form to
: VA Certifying Official
Louisiana College Financial Aid Office
1140 College Drive, LC Box 582
Pineville, LA 71359
PHONE: 318-487-7386 FAX: 318-487-7449
EMAIL: financial_aid@lacollege.edu