Enrollment Change For VA Educational Benefits

Enrollment Change For VA Educational Benefits

Use this form to report a change in your enrollment status or a change in your tuition and fees assessment occurring after you are certified to receive VA education benefits for any of the terms listed below.
Indicate the Semester/Term you are submitting a notice of change.*

FallSpringSummer
Specify which aid year you are submitting a notice of change.*
Legal First Name*
Legal Last Name*
Student/LoLA ID Number*
Email*
Phone Number*
Please enter a valid phone number.
Alt. Phone Number
Please enter a valid phone number.
Current Major/Program*
Select the option that describes the change in your status.*
Based on your response, did you increase or reduce your enrollment?*

IncreasedReduced
I am now registered for # of hours* hours as of Date* .
Based on your response, what date did you change your course section, time, date, or location? Date*
I changed my declared major from Previous Major* to Current Major* as of Date* .
Based on your response, select your mitigating circumstance.*
*Mitigating circumstances are unavoidable or unexpected events that directly interfere with a student’s pursuit of a course andare beyond his/her control. Students must submit corroborative evidence to substantiate their reasons for being unable tocomplete a course(s) or receiving a non-punitive grade.
Identify the date in which you began to experience mitigating circumstance(s). Date* .
I withdrew from all enrolled classes as of Date* .
Attach documentation to justify mitigating circumstance(s).*

Cancelof
Attach a copy of your updated schedule*

Cancelof
Student Acknowledgement*
I, First Name* Last Name* (student), certify that I have read all of the information and is complete and accurate.
Date*

MonthDayYear
Should be Empty: