VETERANS RECERTIFICATION WORKSHEET
ALLEN COMMUNITY COLLEGE


ACC ID NAME
ADDRESS CITY STATE ZIP
SSN PHONE #
I have used my benefits before:NO  YES -- If yes: List where:
  Do you currently owe an overpayment to the VA?no  yes

I plan to use the following benefit - mark only ONE:
 CHPT 30 M Montgomery GI Bill (MGIB)-contributed $
 CHPT 33 Post 9/11 GI Bill available starting Aug. 2009)
 CHPT 1606 MGIB for Select Reserve/National Guard
 CHPT 1606 MGIB for Select Reserve/National Guard w/kicker
CHPT 1607 REAP Reserve/Guard deployed 90 days on or after 9/11/01
Veterans Retraining Assistance Program (VRAP)
CHPT 31 VA Vocational Rehabilitation
CHPT 35 Dependent/Survivor Education Assistance -- VA File #
***MY EXPECTED MONTHLY VETERANS BENEFIT PAY RATE FOR FULL TIME ENROLLMENT IS $***

I plan to enroll at ACC in the:  
I request to be certified to the VA as a:
ACC DEGREE/CERTIFICATE STUDENT - PLEASE LIST PROGRAM:

GUEST STUDENT-PLEASE LIST PARENT SCHOOL:
To be certified, GUEST STUDENTS must request "PARENT SCHOOL LETTER" be sent to ACC Veterans Services Office.

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.