Veteran and Military Services Enrollment Certification
Please reach out to the Veterans Office by texting 903-300-5644
Name
*
First Name
Last Name
A-Number
*
Email
*
example@example.com
Cell Phone Number
*
-
Area Code
Phone Number
Address
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Type of student:
*
First time using benefits @ TJC
Continuing Student- benefit renewal
Continuing Studies/Non-Credit Student
Transient/Visiting/Guest Student
Will you have a civilian third party sponsor or agency helping fund your education?
Yes
No
Do you have a Parent Institute Letter
Yes
No
Major/Program
*
Are you confident in your current Major selection?
Yes
No, I would like more information from Career Planning
Please indicate which benefits you plan to utilize:
Federal benefits
*
Chapter 30 - MGIB
Chapter 31 - Vocational Rehab
Chapter 33 Post 9/11 (Veteran)
Chapter 33 (Dependent)
Chapter 35 (Dependent)
Chapter 1606 - MGIB Selected Reserve
Active Duty Military Tuition Assistance Program (TA)
MyCAA for Active Duty Military Spouses
None
State benefits
*
Hazlewood - Veteran
Hazlewood Legacy
Hazlewood - 100% Disabled Veteran Dependent
None
Sex Assigned at Birth
Please Select
Male at birth
Female at birth
Have you singed up for Selective Service as a requirement for use of Hazlewood
Yes
No
I am planning to use benefits for (select all that apply):
*
May 2024
Summer I 2024 (June 3- July 5)
Summer Special (Extended dates)
Summer II 2024 (July 8- Aug 9)
Fall 2024
Have you submitted your FAFSA?
*
Yes
No
Have you submitted your official military transcripts?
*
Yes
No
What is your goal here at TJC?
*
Associates Degree, core (basics) completion, transfer, general knowledge, etc.
Please read and initial each statement:
I will notify the TJC Veterans Affairs Office of any changes in my class schedule.
*
Courses that are successfully completed with a passing grade may not be re-certified to the VA.
*
I understand that I can only be certified for classes that are on my degree plan.
*
I understand I am responsible for any balances due that may not be covered by my approved benefits and am responsible for any payments due by TJC payment deadlines if VA benefits are still processing.
*
Signature
*
Should be Empty: