Request To Certify Enrollment

Legal First Name*

Legal Last Name*

Student/LoLA ID Number*

Student Social Security Number*

Birth Date*

MonthDayYear

Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code

Phone Number*

Please enter a valid phone number.

Alt. Phone Number

Please enter a valid phone number.

Email*

Term you are requesting to certify*

FallSpringSummer

Year you are requesting to certify*

Ex: 2020

Current Major/Program*

Do you receive any of the following aid? Check all that apply.*

Tuition Scholarship (i.e. TOPS)Tuition Exemption (National Guard)Tuition AssistanceI don't receive any of the above mentioned aid.

Have you ever received VA Educational Benefits at SLCC?*

YesNo

Are you currently on active duty?*

YesNo

Select the VA education program you will receive benefits under.*

Veteran's Full Name*

First NameLast Name

What is the Veteran's SSN (VA File Number)?*

Are you receiving LA State Fee Exemption?*

YesNo

What is your percentage of eligibility?*

Were benefits transferred from a parent or spouse?*

YesNo

Provide the email address of your case manager?*

Attach a copy of your schedule. Need help? See instructions below.*

List all courses applicable to the semester you wish to certify. Select "+" to add additional courses.*

Veteran's Statement of Understanding

Please read and Initial Each Statement

Initial*   I understand that I will need to submit a copy of my Certificate of Eligibility to the SLCC Veteran Certifying Official. (Chapter 1606, 30, 33, and 35)
Initial*   I understand that all official transcripts of prior college work and military schools must be on file and evaluated by the end of the first term of attendance at my primary college. Note: Failure to submit official transcripts will delay further VA enrollment certifications.
Initial*   I understand that each term, I will be required to complete a "Request to Certify Enrollment" form and submit a copy of my "Concise Student Schedule" in order to utilize and continue my education benefits.
Initial*   I understand that it is my responsibility to report any changes (Adds/Drops/Withdrawals/Program Changes) to the SLCC Veteran Certifying Official. Notification of change(s) must be made by completing the "Enrollment Change for VA Benefits form."
Initial*   I understand that enrolled courses, not a part of my curriculum, will not be certified, and I am responsible for paying tuition for these courses. If it is found that I have enrolled in a course that is not within my program in a VA compliance audit or in the proper modality as stated by the VA, I accept the consequences. I understand that it may potentially lead to a debt owed to the Department of Veteran Affairs or South Louisiana Community College.
Initial*   I understand that any changes in my enrollment (submit Enrollment Change for VA Benefits form) will be reported to VA and may affect my payment amount.
Initial*   I understand that I am responsible for all debts owed to SLCC and/or VA resulting from any reduction of my enrollment.
Initial*   I accept the responsibility for monitoring my completed course grades on a checklist as I complete my courses with a passing grade as a means to track my degree progress and to ensure I am taking coursework that is approved for my program. Program curricula is located in SLCC's Catalog which may be accessed on the school's website.
Initial*   I authorize SLCC to certify my enrollment for the above term(s) and release information to VA concerning my academic status.

It is the student's responsibility to contact an advisor prior to registering for courses. Courses that do not apply to the student's program/major will not be certified to the VA. The student will be financially responsible for any course(s) that is not applicable to the student's program.

Today's Date*

MonthDayYear

Are all courses applicable towards student's degree?

YesNo

If "no," specify which course(s) do not apply towards student's degree.