VA Enrollment form
 

 



VA Enrollment Form

Student Information:
  First Name:  (Required)
  Last Name:  (Required)
  Birthdate:  /   /                    [mm/dd/yyyy](Required)
  Student ID:   (Required)

Contact Information:

  Email address:
  Address Line 1: (Required)
  Line 2:
  City:   (Required)
  State:   (Required)
  ZIP:   (Required)

Select one of the following that best describes your status: (Required)

    I am a new student transferring credits from another University or College and I have used my benefits before. (also fill out form 22-1995 or 22-5595)
  I am returning to FTCC after not having attended for at least one semester (including summer).
  I am a continuing student at FTCC, who attended the previous semester.
  I have not used my VA benefits in at least one year at FTCC.
  I am a new VA student that has never used VA benefits.

What degree will you be working towards this semester? (Required)

  AAS
  Diploma
  Certificate
  Visiting Student
    What program have you been approved into? 
   

Is this a change from last semester?                    Yes   No (Required)

Type of benefits that you receive? (Required)

  Chapter 33, 9-11 GI Bill
  Chapter 30, Montgomery GI Bill
  Chapter 1606, Reservist GI bill
  Chapter 1607, Reserve Educational Assistance Program
  Chapter 31, Vocational Rehab
  Chapter 35, Dependents, VA Claim Number:
  Chapter 32, VEAP
  VRAP
     

Semester(s) of enrollment for certification: (Required)

  Fall 16 Weeks Year:   Credit Hours:
  Fall 1st 8 Weeks Year: Credit Hours:
  Fall 2nd 8 Weeks Year: Credit Hours:
  Spring 16 Weeks Year: Credit Hours:
  Spring 1st 8 Weeks Year: Credit Hours:
  Spring 2nd 8 Weeks Year: Credit Hours:
  Summer Year: Credit Hours:

Is this to verify that you want to be certified for the above periods?
                       Yes   No (Required)

Have you read the FTCC VA Student Rules & Regulations?
                  Yes        No (Required)