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Request for Certification of Federal VA benefits
Name (First, middle, last)
Last four digits of Social Security Number
Address (street, city, zip code)
Chapter of benefits
Chapter 33 (post 9/11)
Chapter 30 (MGIB for AD)
CH 1606 (MGIB-SR- reservist and guard without deployment)
CH 1607 (REAP- reservist and guard with deployment)
CH 31 (Vocational Rehabilitation and Employment)
CH 35 (Dependents of 100% disabled veterans)
Are you receiving Wisconsin GI Bill (tuition and fee waiver)
By submitting this form, you are requesting that your enrollment be reported to the Federal VA for payment of education benefits. You also acknowledge the following:
1) The information provided is correct and accurate
2) I give permission for VA representatives to review my educational records
3) I give permission to the Veterans Services Office to release educational and other information necessary for financial aid.
4) I understand that I am responsible for paying fees and tuition within University deadlines
5) I understand that I am responsible for notifying the Veterans Services Office of any changes in my enrollment
6) I understand that unsatisfactory progress will be reported to the VA
7) I understand that changes in my registration may alter the payment the VA will award me.
8) I understand that changes in my registration may cause over-payments which I am responsible to pay.
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