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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:
Zip Code:
Phone Number: -
Email Address:

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



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.

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