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
*
Starts with C00
Major:
*
Email Address:
*
example@my.blueridgectc.edu
Term of Registration:
*
Please Select
Fall
Spring
Summer
Year of Registration:
*
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)
First Name
Last Name
Veteran's SSN (if benefits were transferred to you):
Information entered will be sent securely. If benefits have been transferred to you through Ch 35 or Ch 33, we must have this information in order to certify.
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: