Pacific Northwest Christian College Veteran Intake Form

15955

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Veteran Intake Form

First Name

Last Name

Social Security Number

Date of Birth

Are you Currently serving on Active Duty?

Yes

VA Program You are Eligible For *

Mailing Address *

Mailing Address

City

State/Province

Zip/Postal

Country

Phone Number *

Email Address *

School Related Information

Degree Objective

Is this your first time receiving GI Bill benefits?

I plan to attend

Payment Options

Advance Pay? Advance Pay request must be received by the VA no less than 30 days but not more than 120 days prior to the start of the term. Ch 33 and Ch 1607 recipients are not eligible to receive Advanced Pay. Advance Pay is not guaranteed. Direct Deposit is not available for Chapter 35. *

Statement of Understanding: I must complete this form prior to the start of the academic year (Fall Semester) and prior to the start of the Summer Session. Failure to do so will delay certification of enrollment and GI Bill payments. Contact the G4H VA Office if you don’t wish to be certified for the Spring Semester. Classes not listed on the G4H Degree Audit Report (DAR) will not be certified for enrollment until documentation is provided to confirm the classes are required. (Note: All GERs are listed on the DAR). Failure to do so may reduce training time and result in reduced GI Bill payments. I may only report my major as Bachelor (Undecided) until I reach 60 cumulative credits, and I cannot be VA certified for enrollment beyond 59 credits unless I declare a major. I must complete applicable VA paperwork if I change my progam (major). The VA will only pay benefits to pursue a single degree. Contact G4H VA Office regarding approval of dual majors and minors. I understand that changes in course enrollment at any time may result in the retroactive loss of benefits. I must notify the G4H VA office all changes in enrollment status, classes, and personal contact information. I understand the VA will not pay for audited courses and repeated courses in which the original grade met minimum requirements for graduation. I understand that I must make satisfactory progress toward graduation. I understand that grades "W", "F", may result in a reduced payment from the VA. Incomplete "I" must be completed within one year or an overpayment may occur. I understand that the VA will hold me liable for any overpayment of my GI Bill educational benefits I hereby authorize the release of information contained in my G4H Veteran's educational file to the Veterans Administration. By signing below, I certify that I have read and understand this document, and that all statements are true and complete to the best of my knowledge. *

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Veteran Intake Form

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