UDC VA Education Enrollment Request Form

By checking the boxes below, I acknowledge, understand and agree to adhere to the following (required).

I am the person stated on the top of this form and I authorize UDC Veterans Affairs Office to certify me for the stated semesters I indicated on this form.

Rules and regulations (required)

I am responsible for knowing the rules and regulations of the VA Educational Program. Updates are always found at www.gibill.va.gov.

Disclaimers (required)

I may incur a debt, my enrollment may not be processed, and my paperwork may be terminated if one of the following applies:(a) Major/Minor/Certificate declared with UDC Veterans Affairs office differs from what has been declared with the school, (b) Enrolled in classes not required for my declared Major/Minor/Certificate, (c) Receive failing grades for unofficial withdrawal of course(s), (d) Repeating courses already successfully completed, (e) Adding classes without notifying UDC Veterans Affairs Office, (f) Being academically dismissed from UDC, (g) Not being eligible or no longer being eligible for VA Educational Benefits.

Agreement (required)

I have read this complete form and agree to the policy and procedures on receiving my VA Educational Benefits through the UDC Office of Military and Veteran Student Services.

Responsibility (required)

I accept full responsibility for paying UDC the following: (A) The VA does not pay the school for tuition and fees owed for any reason, and (B) If I receive a refund from the school based on money received from the VA and VA decides the money should not have been refunded.

Pell	Loans
Outside Tuition Scholarship	Institutional Scholarship
Go Army Ed / Federal Tuition Assistance	Employer Waiver / Reimbursement
Guard Grant	None
Other	Please indicate the other funds you will be receiving.