Veterans Education Benefits Enrollment Information

Student ID #
Name*
First
Mailing Address
Street Address City State ZIP Code
Primary Phone
Secondary Phone
Email
Are you:
- Chapter 30 – Montgomery GI Bill (served at least two years on active duty)
- Chapter 31 – VR&E (Veteran Readiness and Employment)
- Chapter 33 – Post 911
- Chapter 33T – Post 911 Dependent
- Chapter 35 – DEA (Survivors’ and Dependents’ Educational Assistance)
- Chapter 1606 - MGIB-SR - Montgomery GI Bill Selected Reserves (Reserves/National Guard)
- TW – Tuition Waiver (Guard/Reserves)
- TWSPS – Tuition Waiver Spouse (Army Guard)
Chapter 33T – Post 911 Dependent
- Spouse
- Child
Chapter 35 – DEA (Survivors’ and Dependents’ Educational Assistance)
- Spouse
- Child
Veteran’s Name Benefits Are Under
First Last
TW – Tuition Waiver (Guard/Reserves)
- Army
- Air
Please certify me for the
- Fall
- Spring
- Summer
Year
Current Program Major
- Degree
- Certificate
Number of credits for current semester, and I certify that all of these courses apply to my program of study.
My signature below indicates that I understand I’m allowing the release of grades or any other information to the Department of Veterans Affairs, National Guard, funding agencies or representatives of these agencies.
Student Signature
Date
MM slash DD slash YYYY

Δ

Berlin (Main Campus)
2020 Riverside Drive
Berlin, NH 03570

Littleton Academic Center
646 Union Street
Littleton, NH 03561

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