VA Enrollment Certification Request

Student Information: Term:
M Number
Last Name First Name
Middle Name Suffix
Home Phone Cell Phone
Address City
State Zip
Current Major
Secondary Mjr (if applicable)
VA Educational Benefits:
Please check all that apply.
I am attending another school during this semester. (ie. Guest Student)

I attended another Institution of Higher Learning prior to MVCC using VA Educational Benefits

I am currently on Active Duty.

By initialing and submitting this form, I confirm that my schedule is finalized and complete with no anticipated changes to be made to this schedule. I further confirm that all classes scheduled apply to my Major(s) and understand that if Veterans Education Services determines a course is inappropriate for the degree(s), that course will not be certified to the VA.

If at any time during the term indicated above, I plan to add/drop a course, withdraw (officially or unofficially) from school, stop attending class(es), change my major(s), or change my status in any way, I will first notify Veterans Education Services. I understand failure to notify Veterans Education Services of such changes could result in financial penalties.

If my contact information has changed (to include address, phone number(s) and email), I give permission to MVCC to update my contact information on file.

Note: By submitting this form, I indicate that I fully understand this information and agree to the conditions.

Student Initial