Kankakee Community College
Veteran Educational Benefits Request Form
PLEASE PRINT.
Name:
LAST
FIRST MIDDLE (FULL)
Date of birth: ____/____/____ KCC I.D. no.: Social Security no. - -
Street address:
City: State: ZIP code:
Phone:
( )
-
Email:
Veteran status: Veteran Active Duty Spouse Dependent
Branch:
Dependent/Spouse only:
Veteran’s Social Security no.: - -
Have any other dependents of this veteran used his/her benefits before you? No Yes If yes, how many?
CHAPTER
Ill. Veteran Grant MIA/POW CH 31/19 (Voc. Rehab)
Post 9/11-CH 33 CH 1606 (Guard & Reserve)
CH 1607/REAP
Ill. National Guard Grant
CH 30 (GI Bill
®
)
CH 35 (Dependents)
CERTIFICATION PERIOD Please answer only if using Federal VA Benefits (CH 30, CH 33, CH 1606, CH 1607, CH 35):
Current degree/major (from the KCC catalog):
TERM **If this is a change of major from your last semester using your GI Bill or you are a new student,
you will need to complete a VA Change of Training/Program form.
I hereby certify that all statements are true and complete to the best of my knowledge and belief:
I authorize release of school and testing records to the VA and Illinois Student Assistance Commission for use in advising me and
supervising my program of education and training.
If I stop attending classes and/or earn a failing grade, the school is required to
report the last date of attendance to the VA and I may owe the VA if the grade was not earned.
I will only be certied for classes that are required for the above stated degree.
I cannot receive payment for audited classes or repeated classes with a grade of D or better, unless it is for graduation requirements.
Registering prior to completion of the ofcial evaluation of high school, college, and/or military transcripts may have nancial
implications, including requirement to return VA funds for which I have previously received credit.
I am held to the same Academic Standing requirements as all students at KCC.
I am responsible for notifying the Ofce of Financial Aid within two weeks of ANY changes in my program/curriculum and semester
hours enrolled.
Non-compliance with school and VA regulations may result in an overpayment which I understand that I must repay.
I must request certication of benets each semester.
Post 9/11 – Chapter 33 benet recipients: The housing allowance is paid if the student’s rate of pursuit is more than 50%. Individuals
only enrolled in distance learning courses will be eligible for a monthly housing allowance equal to 50%. The applicable Basic Allowance
for Housing rate will be multiplied by the rate of pursuit, rounded to the nearest multiple of 10.
Signature of student Date signed
Post 9/11-Chapter 33- tuition and fees (including lab) Vocational Rehabilitation – tuition, service,
Approved percentage of benets lab fees, books
IVG - tuition and service fees MIA/POW tuition and service fees
ING - tuition and service fees
Comments:
Rev. 11/2018
To be completed by the KCC Office of Financial Aid
Gap Access Info. Date:
Points used to date:
IVG:
MIA/POW:
ING:
Award year:
mm/dd/yyyy
First, print form. Then manually sign and send to: Kankakee Community College, Kendra Souligne, Coordinator of Financial Aid and Veteran
Services, 100 College Drive, Kankakee, IL 60901. Question? Contact Kendra Souligne, 815-802-8550 or email finaid@kcc.edu.
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