Veteran Benefits Form - Gordon State College - Barnesville, Georgia

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Gordon College
Office of the Registrar
VETERAN BENEFITS FORM
419 College Drive
Barnesville, GA 30204
Personal Information
Last Name
First Name
MI
Social Security Number
Street Address
Apt/Suite #
City
State
Zip Code
Home Phone #
Cell Phone #
Email Address
GCID (If Known)
VA File # (Ch. 35 Only)
Degree Type (AA, AS, BS, etc.)
Program Type (Psychology, Nursing, Business, etc.)
Term of Enrollment:
____Fall
____Spring
____Summer
Year: ____________________
Check One
____I have submitted my VONAPP (Veteran’s Online Application) online.
____I have NOT submitted my VONAPP online, but plan to do so in the near future.
____I have NOT submitted my VONAPP online, but I have attached one of the following VA forms:
Veteran or Reservist: VA Form 22-1990 (Applying for the first time) OR VA Form 22-1995 (Transfer Students)
o
Dependent or Spouse: VA Form 22-5490 (Applying for the first time) OR VA Form 22-5495(Transfer Students)
o
Check One
___Chapter 30 (MGIB Active Duty)
___Chapter 1606 (MGIB Reserves) ___Chapter 1607 (REAP)
___Chapter 33 (Post 9/11)
___Chapter 31(Voc. Rehab)
___Chapter 35(Survivor & Dependents)
Have you ever used your VA benefits at another school?
___Yes
___No
If you answered Yes, please complete and attach the Request for Change of Program or Place of Training (VA Form 22-1995 for
Veteran/Reservist OR VA Form 22-5495 for Dependent/Spouse).
Check One
st
nd
rd
I am the ____1
____2
____3
dependent under Ch. 35 to use benefits.
I am the ____spouse of a veteran.
VA File Number (Required for Chapter 35 ONLY) ______________________________
Please review the following information and initial by each:
Initials
I understand that….
In order to receive VA Benefits, You MUST DECLARE A MAJOR and have official acceptance to Gordon College. This
major must correspond with the major listed on your application for Veteran Benefits
If you wish to change your education objective, you MUST submit a request for a Major Change with the Registrar’s Office
at Gordon College.
Credit for prior training is required; therefore all students requesting VA Benefits MUST have official transcripts submitted
to the school and have them evaluated.
Every semester you register and choose to use VA benefits YOU ARE RESPONSIBLE for paying your tuition and fees
(Except Chapter 31 and Chapter 33 with the right documentation)
You MUST take courses that are in your approved major at Gordon College. If you are taking classes outside of your major,
your enrollment will be reduced and your payments may be affected.
All Chapter 30, 1606 and 1607 Veterans are responsible for verifying their enrollment at the end of every month. You can
verify your enrollment at 1-877-823-2378 or via internet at www.gibill.va.gov, and click on WAVE.
I understand that I am responsible for notifying my schools Certifying Official of each semester that I enroll in classes and
of any adjustments (increase or decrease in hours) in enrollment.
Signature___________________________________________________ Date___________________________________
Gordon College
Office of the Registrar
VETERAN BENEFITS FORM
419 College Drive
Barnesville, GA 30204
Personal Information
Last Name
First Name
MI
Social Security Number
Street Address
Apt/Suite #
City
State
Zip Code
Home Phone #
Cell Phone #
Email Address
GCID (If Known)
VA File # (Ch. 35 Only)
Degree Type (AA, AS, BS, etc.)
Program Type (Psychology, Nursing, Business, etc.)
Term of Enrollment:
____Fall
____Spring
____Summer
Year: ____________________
Check One
____I have submitted my VONAPP (Veteran’s Online Application) online.
____I have NOT submitted my VONAPP online, but plan to do so in the near future.
____I have NOT submitted my VONAPP online, but I have attached one of the following VA forms:
Veteran or Reservist: VA Form 22-1990 (Applying for the first time) OR VA Form 22-1995 (Transfer Students)
o
Dependent or Spouse: VA Form 22-5490 (Applying for the first time) OR VA Form 22-5495(Transfer Students)
o
Check One
___Chapter 30 (MGIB Active Duty)
___Chapter 1606 (MGIB Reserves) ___Chapter 1607 (REAP)
___Chapter 33 (Post 9/11)
___Chapter 31(Voc. Rehab)
___Chapter 35(Survivor & Dependents)
Have you ever used your VA benefits at another school?
___Yes
___No
If you answered Yes, please complete and attach the Request for Change of Program or Place of Training (VA Form 22-1995 for
Veteran/Reservist OR VA Form 22-5495 for Dependent/Spouse).
Check One
st
nd
rd
I am the ____1
____2
____3
dependent under Ch. 35 to use benefits.
I am the ____spouse of a veteran.
VA File Number (Required for Chapter 35 ONLY) ______________________________
Please review the following information and initial by each:
Initials
I understand that….
In order to receive VA Benefits, You MUST DECLARE A MAJOR and have official acceptance to Gordon College. This
major must correspond with the major listed on your application for Veteran Benefits
If you wish to change your education objective, you MUST submit a request for a Major Change with the Registrar’s Office
at Gordon College.
Credit for prior training is required; therefore all students requesting VA Benefits MUST have official transcripts submitted
to the school and have them evaluated.
Every semester you register and choose to use VA benefits YOU ARE RESPONSIBLE for paying your tuition and fees
(Except Chapter 31 and Chapter 33 with the right documentation)
You MUST take courses that are in your approved major at Gordon College. If you are taking classes outside of your major,
your enrollment will be reduced and your payments may be affected.
All Chapter 30, 1606 and 1607 Veterans are responsible for verifying their enrollment at the end of every month. You can
verify your enrollment at 1-877-823-2378 or via internet at www.gibill.va.gov, and click on WAVE.
I understand that I am responsible for notifying my schools Certifying Official of each semester that I enroll in classes and
of any adjustments (increase or decrease in hours) in enrollment.
Signature___________________________________________________ Date___________________________________

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