Veterans Freedom Center in Gullo II, evcvet@evc.edu or (408))223-6789
[Type here]
06/22/20
Eligible Veterans or dependants must submit this form each semester if they wish to receive Educational
Benefits. Upon receipt of your VA Certificate of Eligibility (COE); students submit the COE along with
this Class Certification Form and supporting documentation through the Veterans Freedom Center.
Veterans Certification of Benefits deadline https://www.evc.edu/future-students/academic-calendar
Name: _____________________________ Student ID# _____________ File #(Dependent)_________________
Last, First -Middle
Phone#: ________________ Address: ___________________________________________________________________
Chapter: Check one □ 30(MGIB AD) □ 31(Voc Rehab) □ 33(Post 9-11) □ 1606(Reservist) □ 35(Dependent)
Most Recent Ed Plan/Date: ________ Objective: □AA □ AS □Certificate of Achievement □Transfer UC/CSU
Your Educational Goal as identified on your Ed Plan: ___________________________________________
Student Status: (check one): □ New student □ Enrolled at EVC Last Semester □ Returning to EVC (after a 2-semester break)
Will you be attending EVC next semester: □ Yes □ No All prior college transcripts submitted: □Yes □No
If concurrently enrolled in another institution: (which) ________________________________________________
Semester are you certifying enrollment: Choose one: □Winter □Spring □ Summer □Fall
List All Courses for Semester You are Applying For
(*Remote = On-site , Distance Ed = Online)
□ I certify that the above information is correct
□ I am aware that the VA will only pay for classes that are on my Ed Plan
□ I am liable for any overpayment that may occur due to enrollment errors, or failure to report changes.
Signature: __________________________________________________________________________ Date: ________________________
Effective August 1, 2009. Students whose enrollment was exclusively distance
learning training were not eligible for the monthly housing allowance (MHA).
Learning training were not eligible for the monthly housing allowance (MHA).
