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 Ofce (RPC 110) on ECTC main campus.
• It is your responsibility to inform this VA Ofce of any changes in your enrollment to include: any drops, adds, or changes
of major; changes in address, phone # etc. each semester.
• Benets 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 ofcial degree audit showing the student is in
their graduating semester and a copy given directly to the ECTC VA Certifying Ofcial.
• 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 ofce.
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 Certicate: _________________________
________________________________________________________________
** Major is required for those enrolled in AAS, Diploma, and Certicate program
like Human Services, Business Admin., Industrial Maintenance Technology, etc.
Major:
VA BENEFITS INFORMATION
Which Chapter of Benets 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 ofce 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 benets and certication by ECTC cannot be made until the Certifying Ofcial 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 benets 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 deciency courses taken online cannot be approved and cannot be certied 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 Ofce.
** This form must be signed and dated by the person requesting certication.**
Signature: ______________________________________________________ Date: _________________________________________
Created 12/12/2019
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