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Midland College
Veterans Request for Certification


• I am eligible to receive VA educational benefits and request that my enrollment for this term be certified with VA.
• I understand that only courses which are listed on my declared Midland College degree plan can be certified.
• I am not repeating any courses previously taken and completed as permitted by VA regulations.
• I will notify the Midland College VA Rep of any changes to my enrollment, address, status, or degree plan.
• Students will be responsible for their tuition and fees at the time of registration. CH 33-Upon certification funds received will be credited to the outstanding balance due to Midland College. Any remaining funds will be refunded to the student.
• Please note that students may use the FACTS Tuition Monthly Payment Plan. Log in to Campus Connect>Student Information>Review/Pay Bill.
• I assume full responsibility for payment to Midland College or the VA should an over-payment occur as a result of this certification.


Student Full Name:
Student ID #:
Street Address:
City:
State:
Zip Code:
Phone Number: -
Email Address:

(I understand all communication regarding my VA benefits will be sent to my official MC email address)


Term:

Year:

Declared Degree Plan:


Are you currently on Active Duty?



Are you receiving Military TA for this term?



Benefits you are using?


Check the appropriate status box:

New student: This is the first school where you have used the VA educational benefits.
Continuing Student: You have receieved benefits at this school last semester.
Guest Student: Receiving degree and being certified at another school (PIL Required)

 

Course ID Hours


I have read and understand it is my responsibility to agree and comply with the above information. All information provided on this form is true.
Date:


Please select the button to the right to submit your information: