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Last ______________________________________ First: _______________________________
Address: ______________________________________________________________________
City: __________________State: ______ Zip Code: __________ Phone ____________________
Student ID#: _________________________SSN: ______________________________________
VA File#: ______________________Major/Program: ___________________________________
Email: ______________________________________ Semester: ____________ Date: ________
Benet
□ Chapter 33 (Post 911) Acve Duty/Veteran □ Chapter 35 (Spouse/Dependent)
□ Chapter 33 (Post 911) Transferred Benets □ Chapter 30 (MGIB)
□ Chapter 33 (Post 911) Fry Scholarship □ Chapter 1606 (Res. Guard)
□ Chapter 31 (Voc. Rehab.) □ Tuion Assistance/TA
Service Branch
□ Army □ Navy □ Air Force □ Marine □ Coast Guard □ Reservist
□ Guard
Current Status/Posion
Acve Duty: _____Yes _____No Veteran: _____Yes ____No
Reservist: _____ Yes _____No Guardsmen: _____ Yes _____No
Spouse: _____Yes _____No Dependent/ Child: _____Yes _____No
Courses must be required per the appropriate program/major and could not have been
previously completed with a passing grade at ACC or any other college. All course substuons
must be properly documented on an approved Course Substuon Form. Developmental
courses must be required per Placement Test results. The VA and Financial Aid will only cover
classes that are a part of your major. The student is nancially responsible for the tuion/fees as
well as the repayment of VA educaon benets received for any course(s) taken which do not
meet the aforemenoned criteria.
Student Inial________.
Except for Chapter 31 (Voc. Rehab), VA students can round out a schedule with non-required
courses to bring his/her course load up to a full-me schedule in his/her last term. This allows
students to receive full-me benets, even though less credits are required to complete the
program.