since 2011since 2010
SLCC VETERANS INFORMATION

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Name: ______SS#: ______SID# ______

Address: ______City______State ____ Zip ______
Phone: ______Cell: ______

SLCC Email: ______Personal email: ______

Beginning term ______This form is to update my information only ____

Which benefitwill you be using (check any that apply):

( ) Chapter 30 (former/current active duty)( ) Chapter 1606 (Reserve/Guard)

( ) Chapter 31 (Vocational Rehabilitation)( ) Chapter 1607 (Reserve/Guard activated-Title 10)

( ) Chapter 33 (Post 9-11 GI Bill)

( ) Chapter 33 (Fry Scholarship-dependents)( ) Chapter 35 (Dependent) VA File # ______

( ) Chapter 33 (Transfer of Entitlement)( ) MyCAA

( ) Purple Heart Waiver ( ) Secondary School Attendance- Parent School ______

( ) State/Federal TA: GoArmyEd, Air NG( ) Other:______

____ CH 33 students: I understand I may not use any combination of benefits to result in a surplus of funds designated for tuition/fees. VA will be last payer. Allother education fundspay 1st and any remaining money due will be paid by the VA. Using Ch 33 in combination with any other education benefit, MAY result in you owingtuition/fees due.

____ SLCC is required to report to the VA all prior credit you have earned. You are required to immediately requestALL transcripts from previous colleges, universities and military training including AARTS, SMART, DANTES and CLEP transcriptsandsubmit a request for the college to evaluate them.

____ I understand I must request all transcripts now. If not done by the 2nd termends SLCC is required to report my non-compliance to the regulations, withhold certification and I may be placed in overpayment by the VA.

Please list ALL colleges, universities previously attended: ______

______

____ I understand my major must always be the same with the VA as it is with SLCC as identified with the college.

My Educational goal at SLCCis:

____ Graduate from SLCC___Take a few classes to transfer ____Take classes for employment advancement

____I understand the VA will only pay for classes listed in the SLCC catalog as required for my major.

It is my accountability to know what classes are required for my declared degree.

You will be subject to all SLCC and VA regulations including those described on your Welcome Letter. It is in your best interest to read all documents carefully.

______

Student’s SignatureDate

Salt Lake Community College- Veterans Services PO Box 30808 Salt Lake City, UT 84130
Taylorsville Redwood Campus 4600 South Redwood Road- STC 059 (801) 957-4289 FAX: (801) 957-4987
South City Campus 1575 South State Street, SC 1-061H-B (801) 957-3010 FAX: (801) 957-3150

FORM-Student Information Sheet- SLCC- Veterans Serviceslast modified: 07/15/14