Veteran Enrollment Reporting Form
This form is to be completed each semester that a student wishes to have VA benefits certified. No benefits will be certified without a complete form. For any questions, please contact VetSource@blueridgectc.edu.
Student Name
*
First Name
Last Name
Student ID
*
Major:
*
Email Address:
*
example@example.com
Term to be Certified:
*
Please Select
Fall
Spring
Summer
Year to be Certified:
*
Select Chapter Benefits
*
Please Select
Chapter 30: Montgomery GI Bill-Active Duty
Chapter 31: Veteran's Readiness and Employment
Chapter 33: Post 9/11 GI Bill (Veteran)
Chapter 33: Post 9/11 GI Bill (Transfer from Veteran)
Chapter 33: Fry Scholarship
Chapter 35: Survivors and Dependents Educational Assistance
Chapter 1606: Montgomery GI Bill-Selected Reserve
Chapter 1607: Reserve Educational Assistance Program
Veteran's Name (if benefits were transferred to you):
Certification and Signature
I certify that the courses I am registered for during the semester and year listed above lead toward my degree. I hereby authorize the VA Certifying Official to release information to the Veteran's Administration concerning my status as a VA student at Blue Ridge CTC. I will immediately notify the VA Certifying Official of all changes that occur in my enrollment by emailing VetSource@blueridgectc.edu. I understand that failure to do so may result in a delay of payment or an overpayment with the VA. I also understand that if I stop attending my classes, the VA will be notified, and this may cause an overpayment with the VA.
I agree with the certification statement above:
Yes
Today's Date:
*
-
Month
-
Day
Year
Date
Signature
*
Submit
Should be Empty: