Veteran Educational Certification Request

This form must be submitted every semester you are enrolled or when adjusting your schedule.

Please complete and submit the online form below.
Note that your curriculum code is required to complete this form. The curriculum code is a reference number (no letters) for your degree or certificate program.

Name * Required
First Middle Last
Phone * Required
LCCC Student Number * Required
Address * Required
Street Address City State ZIP Code
LCCC Student Email Address * Required
(Your LCCC email address begins with the username for your MyCampus account and ends in @mail.lorainccc.edu)
Personal Email Address * Required
Semester * Required
- Fall
- Spring
- Summer
Year * Required
Assigned Academic Advisor * Required
Your Assigned Academic Advisor can be found on your MyCampus Account
Current Major * Required
See the link above for the list of Majors
Curriculum Code * Required
(4-digit number - See the link above for the list of Curriculum Codes/Majors)
Second Major, if applicable
(See the link above for the list of Majors)
Curriculum Code for Second Major, if applicable
(4-digit number - See the link above for the list of Curriculum Codes/Majors)
Has your major changed since last semester? * Required
- Yes
- No
Is this the first time you are submitting your schedule for this semester? * Required
If you are uncertain if the courses you have registered for are required in your degree, you should consult with your advisor before requesting enrollment certification.
- Yes
- No
Have you made any changes to your schedule? * Required
Note: If you stop attending class and receive a failing grade, VA will not pay for that class. If you withdraw, be sure to advise your SCO about any mitigating circumstances. Changes to your schedule may affect your monthly benefits and payment rates.
- No, this is my first time submitting this semester’s schedule
- Yes, added a class(es)
- Yes, dropped a class(es)
- Yes, withdrew from a class(es)
- Combination of add/drop/withdraw
If this is a University Partnership Program, please provide the information below
University Name
UP Program Name
Courses to be Certified * Required
Enter each course below (i.e.: Course Abbreviation and Number HLED 151 Credit Hours 3). Click the Plus Sign to add additional courses.
Course Abbreviation and Number Credit Hours
Will you be using any additional funding sources? (i.e. Grants, Scholarships, Tuition Assistance)
For each additional source click on the plus symbol to add another row.
Your Branch of Service
- Army
- Navy
- Air Force
- Marine Corps.
- Coast Guard
- No Military Sevice
- Not indicated
Current Military Status - I am...
- Not Indicated - A person whose military status was not indicated.
- No Military Service - A person who has no former or current military service.
- Vietnam Era Veteran - A person who is a Vietnam Veteran.
- Other Veteran - A person who is a veteran, but not from the Vietnam Era.
- Active Reserve - A person who is currently Active Reserve.
- Inactive Reserve - A person who is currently Inactive Reserve.
- Retired - A person who is currently retired from the military.
- Active Duty - A person who is currently on Active Duty.
- Current Spouse/Dependent
GI Bill Benefit Chapter
- CH. 30 - Montgomery G.I. Bill - Active Duty
- CH. 31 - Vocational Rehabilitation
- CH. 33 - Post 9/11 G.I. Bill
- Ch. 33 (T.O.E.) - Post 9/11 Transfer of Entitlement
- CH. 35 - Dependents' Educational assistance
- CH. 1606 - Montgomery G.I. Bill - Selected Reserve
If you are a new student, have you used your G.I. Benefits at another college?
Note: If so, you will need to complete VA Form: 22-1995 Change of Program/Place of training.
- Yes
- No
Are you going to graduate at the end of the semester? * Required
- Yes
- No
I confirm that I have read and acknowledge my responsibility to the above. * Required
- Yes
- No
Comments
Date * Required
CAPTCHA

*GI Bill® is a registered trademark of the U.S. Department of Veterans Affairs (VA). More information about education benefits offered by VA is available at the official U.S. government web site

Course Abbreviation and Number	Credit Hours

Veterans

Veterans

If this is a University Partnership Program, please provide the information below