Veterans Affairs Office
Veterans Enrollment Form
Directions: Complete this entire form, every semester, after you are scheduled into classes, and return it to the
Veterans Affairs Ofce (RPC 110) on ECTC main campus.
It is your responsibility to inform this VA Ofce of any changes in your enrollment to include: any drops, adds, or changes
of major; changes in address, phone # etc. each semester.
Benets can only pay for courses that are required for the student’s CURRENT degree program.
Veterans can repeat classes only if the previous grade was not passing.
No payment can be received for audited courses or for any remedial courses taken online.
A student cannot round out until the ECTC Registrar has conducted an ofcial degree audit showing the student is in
their graduating semester and a copy given directly to the ECTC VA Certifying Ofcial.
Student is required by law to submit all prior transcripts and documents that can be used to establish prior credit.
STUDENT INFORMATION
LAST NAME: ____________________________________
FIRST NAME: __________________ M.I.:____________
ADDRESS: ______________________________________
CITY: ________________________ STATE: ___________
ZIP: ______________ NEW ADDRESS? Y / N
PHONE:
________________________________________
STUDENT EMAIL: ____________________@KCTCS.EDU
STUDENT ID#:
__________________________________
LAST 4 SSN: ____ ____ ____ ____
VISITING STUDENTS
Are you a Visiting Student? Y / N
Home School Name:
_____________________________________________
** REQUIRED: Turn in Visiting Student Letter from the
VA representative of home school to our ofce.
VA CERTIFICATION INFORMATION
Semester (circle one): SPRING
(Jan-May)
SUMMER
(June-July)
FALL
(Aug-Dec)
Year:
_____________
# of Credit Hours: ______ Is this a change to your initial request? Y / N
Degree (AA, AS, AAS)
(AA: Associate in Arts, AS: Associate in Science, AAS: Associate in Applied Science)
, Diploma, or Certicate: _________________________
________________________________________________________________
** Major is required for those enrolled in AAS, Diploma, and Certicate program
like Human Services, Business Admin., Industrial Maintenance Technology, etc.
Major:
VA BENEFITS INFORMATION
Which Chapter of Benets do you receive? (Check One)
CH 30 (Montgomery GI Bill Active Duty)
CH 33 (Post 9/11 GI Bill)
CH 31 (Vocational Rehabilitation)
CH 35 ** (Dependence Education Assistance Program)
CH 1606 (Montgomery GI Bill-Selected Reserves)
CH 1607 (Reserve Educational Assistance Program)
TWO (Tuition Waiver Only)
** CH 35 recipients: Do you receive a tuition waiver? Y / N
My Signature Below Indicates:
1. The information given is correct and accurate and I give permission to the VA ofce to release educational information
necessary for nancial aid determination.
2. I understand I am responsible for paying fees and tuition costs within the deadlines established by ECTC.
3. I understand I will only be paid for courses/classes that are required for my degree.
4. Payment of benets and certication by ECTC cannot be made until the Certifying Ofcial receives all required documents.
5. I understand that if I have previously completed a class elsewhere that is the equivalent to a course I’m currently taking, I will not
receive VA benets for the current class.
6. If you are a CH 33 recipient, you must be enrolled in at least one class on campus and more than half time to receive a Basic
Allowance for Housing. Students enrolled in solely distance learning courses are only authorized ½ national average for BAH.
7. Remedial and deciency courses taken online cannot be approved and cannot be certied by VA.
8. If you are a chapter 33 student and receive other nancial assistance (excluding loans/title IV funds), you must inform the
Veterans Affairs Ofce.
** This form must be signed and dated by the person requesting certication.**
Signature: ______________________________________________________ Date: _________________________________________
Created 12/12/2019
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