UDC Student ID # (required)

First Name (required)

Middle Name

Last Name (required)

Address (required)

City (required)

Zip Code (required)

Your Email

Cell Phone

Work Phone

Home Phone

What is the program of study you are seeking?

Major

Minor

Certificate

Please check the semesters you plan on attending
Spring 2024Summer 2024Fall 2024
Are you attending
Undergraduate StudentGraduate StudentCertificate Seeking Student
Regarding your VA Educational Benefits, are you a
Returning student (UDC is the last school you utilized your benefits at)New Student (First time utilizing your VA Educational Benefits)Transfer Student (Utilized your benefits at another institution prior to UDC)
If You Are a Transfer Student; Please List Last School Benefits Were Utilized at:

VA Educational Benefits you are applying for
Chapter #33 (Post 9/11)Chapter #33 (Post 9/11 - Spouse or Parent Transferred Benefit to you)Chapter #31 ( Vocational Rehabilitation)Chapter #35 (Spouse / Dependent of Disabled Veteran)Chapter #1606 ( Reservist / National Guard)Chapter #1607 ( Reservist / National Guard with qualified active duty time)Sgt Fry ScholarshipVRAPChapter 30 (Prior Active Duty)

Chapter 35 Recipients File #

Processing can't be completed without #
Are you currently on Active Duty?
YesNo
Are you currently a
ReservistNational Guardsmen
Are you a veteran?
YesNo
Are you participating in ROTC?
YesNo
Branch of Service you Served in
ArmyNavyAirforceMarineCoast GuardNot Applicable

Total Active Duty Service Time

Months

Years

Not Applicable

Are you an OEF/OIF Veteran?
YesNo
Will you receive a GI Bill ® Kicker?
YesNo
Will you receive the VA College Fund?
YesNo
Please check all funds you will be receiving for semesters enrolled
PellLoansTuition ScholarshipsGo Army Ed/Federal Tuition AssistanceEmployer Waiver/ReimbursementGuard GrantNone
Other:

By checking the boxes below, I acknowledge, understand and agree to adhere to the following:
I am the person stated on the top of this form and I authorize UDC Veterans Affairs Office to certify me for the stated semesters I indicated on this form
Rules and regulations
I am responsible for knowing the rules and regulations of the VA Educational Program. Updates are always found at www.gibill.va.gov
Resubmission
If I withdrew from a semester, I will need to re-submit this form to receive my VA Educational Benefits for any future semesters
Correspondences
All correspondences will be via UDC email, text and Grades First system
Disclaimers
I may incur a debt, my enrollment may not be processed, and my paperwork may be terminated if one of the following applies:(a) Major/Minor/Certificate declared with UDC Veterans Affairs office differs from what has been declared with the school, (b) Enrolled in classes not required for my declared Major/Minor/Certificate, (c) Receive failing grades for unofficial withdrawal of course(s), (d) Repeating courses already successfully completed, (e) Adding classes without notifying UDC Veterans Affairs Office, (f) Being academically dismissed from UDC, (g) Not being eligible or no longer being eligible for VA Educational Benefits
Student Orientation
I must complete a mandatory student orientation with UDC Veteran Affairs Office; if I have never completed an orientation; I am a new or transfer student to UDC
Agreement
I have read this complete form and agree to the policy and procedures on receiving my VA Educational Benefits through UDC Veterans Affairs Office
Responsibility
I accept full responsibility to pay UDC the following (A) The VA does not pay the school for tuition and fees owed for any reason (B) If I receive a refund from the school based on money received from the VA and VA decides the money should not have been refunded

Please make sure you check all boxes.

I would like to receive more information on UDC Veteran Student Association
YesNo
I would like to sign up for text alerts from UDC Veterans Affairs Office regarding my benefits: Events and Updates:
YesNo
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