Name
(Print) _______________________________________________________ Date of birth ___________________
Last First MI
SSN:
* SID:
*Your social security number is confidential and, under a federal law called the Family Educational Rights & Privacy Act, BBCC will protect it from unauthorized use and/or disclosure. In compliance with state/federal
requirements, disclosure may be authorized for the purpose of state/federal requirements; disclosure may be authorized for the purpose of state and federal financial aid, Hope/Lifetime Learning tax credits, academic
transcripts, assessment or accountability research.
CONTACT INFORMATION
In order to avoid mailing problems, it will be your responsibility to keep the BBCC Veterans Office, Financial Aid Office and
Admissions/Registration informed of changes in your address and phone number.
Mailing Add
ress: Street ___________________________________________________________________________
City ____________
__________________________, State ___________ Zip _______________
Phone _____________________________ Email ______________________________________
BENEFIT
Montg
omery (CH 30) Guard/Reserve (CH 1606) REAP (CH 1607… Guard/Reserve activated 90
continuous days or more)
Depend
ent (CH 35) CH 31 Post 9/11 (CH 33) Post 9/11 (CH 33…TEB)
PLEASE CHECK ALL THAT APPLY
I req
uest a change in place of training from (list prior school and last date attended)
_______________
_______________________________________________________________________________
BBCC
Program ___________________________________________ Intent ______________________________
I am
requesting a change of program. NEW PROGRAM: _______________________________________________
COLLEGES ATTENDED (List ALL colleges previously attended)
College
Dates Attended
Program
Big Bend
Community College does not discriminate on the basis of race, color, national origin, gender or age in its
programs and activities. Person(s) with a disability requiring any auxiliary aids or accommodations should contact the college.
509.793.2061
FAX 1.888.820.2896
7662 Chanute Street
Moses Lake, WA 98837-3299
http://www.bigbend.edu
Veterans Reporting Form
Elise Warren
Phone: 509.793.2452
Fax: 1.888.820.2896
Email: elisew@bigbend.edu
STATEMENT OF UNDERSTANDING READ AND INITIAL EACH ITEM BELOW
1. I understand that my VA benefits will not be certified for any quarter until I submit an Academic Program Plan signed by my
advisor to the BBCC Veterans School Certifying Official, and contact her/him confirm that I have finished registering for
classes for that quarter. Furthermore, I understand that I must complete a new ‘Veterans Reporting Formfor any changes to
mailing address, email, phone, or change of program.
2. I understand that I must meet with an academic advisor and obtain an education plan for the BBCC degree or certificate
program I pursue. The courses I take must fit within my education plan. If I decide to change my degree or program, I must
inform both the Veterans and Admissions offices and meet with an academic advisor to obtain another education plan.
3. I understand I am required to submit my DD214 (member 4), and a copy of VA Certificate of Eligibility. Furthermore, I
understand if I previously attended another college or university, I must submit official transcripts within the first three (3)
quarters I attend BBCC. The VA will not pay for classes I have previously passed with at least a 1.0 GPA, UNLESS my degree
program requires a higher course GPA for graduation and my previous course grade was below a 2.0 GPA.
4. I understand that I am required to attend classes all quarter. I understand that I must report any changes to my quarterly class
schedule (after my initial registration) immediately to the BBCC Veterans Certifying Official. I understand the impact of
receiving a “W”, “I”, orN” grade. Failure to attend all of the classes for which I was certified with the VA may result in my
having to repay benefits I received.
5. Classes for which an “I” (incomplete) is awarded must be completed by the end of the subsequent quarter
(excluding summer). Otherwise, my entitlement for benefits for that course may be reduced and may result in an
overpayment.
6. I understand I am required to make satisfactory progress toward my degree by maintaining a quarterly 2.0 GPA.
7. I understand that payment for remedial math and English classes (below 100 level) will not be allowed unless need for such
class(es) is established by a placement test. They must be a resident course, as the VA will not approve remedial online or
hybrid courses.
8. I understand that the VA will hold me responsible for any overpayment of my educational benefits.
PERMISSION TO RELEASE RECORDS
Federal law and BBCC policy prohibits the release of a veterans records (even to parents or spouse) without written
permission from the veteran. Please check and fill in all areas that apply to indicate your authorization to release, or not
release, your veteran information. You may change your authorization at any time by contacting the Veterans
Coordinator. Your authorization will be effective for the current academic year only.
Parent (
name/s) _________________________________________________________
Spouse (nam
e) _________________________________________________________
Other _________________________________________________________
I do not w
ish to utilize any of the above three options. Do NOT release information to anyone.
I HAVE READ, UNDERSTAND, AND COMPLETED THE ABOVE “STATEMENT OF UNDERSTANDING” AND “PERMISSION TO
RELEASE RECORDS” AND DECLARE THE INFORMATION IN THIS APPLICATION TO BE ACCURATE AND WISH TO APPLY FOR
VA BENEFITS AT BIG BEND COMMUNITY COLLEGE.
Print Name: ____________________________________________________ Date: ___________________
Signatu
re: _____________________________________________________________________________