NEW STUDENT DATA FORM for VA Education Benefits
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1801 N Cottonwood Iola, KS 66749
Phone: 620.365.5116 ext.6291
Fax: 620.365.7403
Name
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First Name
Last Name
Email Address
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Phone Number
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Must contain only numbers
Address 1
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Address 2
City
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State
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Zip
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Please select which benefit you plan to use:
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CHPT 30 M Montgomery GI Bill (MGIB)
CHPT 33 Post 9/11 GI Bill
CHPT 1606 MGIB for Select Reserve
CHPT 31 Veteran Readiness & Employment (VR&A)
CHPT 35 Dependent's Education Assistance (DEA)
Unknown
What Semester do you plan to enroll at Allen in?
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SUMMER
FALL
SPRING
Of what year?
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What do you request to be certified to the VA as?
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Allen Degree/Certificate Student
Guest Student
Please list Program Degree/Certificate
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Please List Parent School
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To be certified, you must request a "PARENT SCHOOL LETTER" be sent to Allen Veterans Services.
Changes to your course schedule OR enrollment in classes outside your current compliance agreement, repeating successfully completed classes, or enrolling in short-term classes, may result in the VA determining an overpayment in your benefit - all overpayments are the responsibility of the benefit recipient.
You must attend class and make satisfactory academic progress as defined in the ACC Student Handbook.
You must submit a Veterans Recertification Worksheet to the ACC Veteran Services office to have subsequent semester enrollments certified to the VA.
Prior credit from all previous colleges, as well as your DD214, must be evaluated and credited toward your degree/certificate requirements.
If you change your ACC degree/certificate intent, you must notify the ACC Veteran Services office and complete a new Compliance Agreement.
The ACC VA Office corresponds via the ACC student email system. It is your responsibility to check your ACC student email account.
Terms of Service
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By submitting this form I state that I have provided accurate information, have read and understand the above statements, and agree to comply with all VA guidelines
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