Veterans Affairs Enrollment Verification Form

Name*

First NameLast Name

Date of Birth*

Date

Student ID (Lola Number)*

Email*

example@example.com

Phone Number*

Please enter a valid phone number.

Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code

Enrollment Certification (All classes MUST be in your program of study)

Semester of Verification*

SummerFallSpring

Academic Year*

Number of hours you plan to take*

To verify enrollment and receive approval for benefits, you must come into the Office of Student Services and provide a copy of your Certificate of Eligibility. Apply for your Certificate of Eligibility at www.va.gov.

Indicate the VA Educational Program you will receive benefits under:*

Chapter 30 (Montgomery GI Bill -Active DutyChapter 1606 (Montgomery GI Bill -Selected Reserve)Chapter 33 (Post 9/11 GI Bill)Chapter 31 (Voc. Rehab)Chapter 1607 (REAP)Chapter 35 (Dependent) VA File NumberLouisiana National Guard Service MemberChapter 29 (Dependent) Must submit fee exemption certificate

What is your percentage of Eligibility? *

Were benefits transferred from a parent or spouse?*

YesNo

Case Manager*

VA File Number*

Select the option that best describes you:*

I have never used VA benefits, but I have completed an application for VA Educational Benefits.I have used VA Educational Benefits while attending RPCCI am transferring to RPCC this semester and I have completed a Change of Place Training form

In order to receive and retain my VA Educational Benefits, I understand that:

Certification of Classes
- I must be enrolled in an approved program of study, RPCC's Academic Programs, that leads to a degree or certificate and have all prior transcripts on file with River Parishes Community College.
- any additional classes not in my degree program cannot be certified for Veteran's educational benefits (this includes developmental courses).
- I will not be paid for courses previously passed at RPCC or other institutions.
Withdrawal from Classes
- I must notify the RPCC Office of Financial Aid of any class changes or withdrawals. Failure to do so may result in the termination of benefits and possibly having to repay initial VA Educational monthly awards.
- if I withdraw from a class (W), RPCC must report this grade to the VA along with my last date of attendance.
  - this grade will not inpact my GPA but will reduce my enrollment and payments from the VA which can create a balance owed to RPCC and/or VA that includes but not limited to book voucher/stipend, monthly housing allowance, and/or tuition & fees monies.
Attendance of Classes
- I must maintain Satisfactory Academic Progress (SAP) toward my educational degree.
- that it is my responsibility to understand all aspects of my benefit.
- I may contact:
  - RPCC School Certifying Official at financialaid@rpcc.edu
  - the VA directly via phone at 888.442.4551
  - VA website (www.gibill.gov) for more information

What Happens if I am Determined to be Deemed Ineligible?
If I am determined to be ineligible for VA Benefits, the awarded funds will will be removed from my award/account which will create a balance owed to RPCC that I will be 100% responsible for repayment.

Signature

Please upload your COE, copy of your ID, and any other documentation needed (tuition/fee exemption forms)*

River Parishes Community College does not discriminate on the basis of race, color, national origin, sex, disability, or age in its programs and activities. **To contact individuals designated to handle inquiries regarding non-discrimination policies, click here.