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GI Bill Enrollment Form
EACH semester you must fill out this form to notify us that you wish to use your GI Benefits for the upcoming semester. This must be done for any winter intersession or summer classes you plan to take as well.
If, at any time, your enrollment plans change and you drop/add classes or withdraw from the University completely, you must inform the Veteran Services Office. FAILURE TO DO SO MAY RESULT IN THE STUDENT OWING MONEY TO PENN WEST CLARION OR TO THE VA OFFICE!
Name
*
First
Last
Penn West ID Number
*
Penn West Email
*
Degree Seeking
*
Please select
Undergraduate
Graduate
Campus Location
*
Please select
Clarion Campus
Venango Site
Pittsburgh Site
Somerset Site
Online Campus
Major
*
Type of GI Benefit
*
Please select
Chapter 33 (Post 9/11)
Chapter 1606 (Montgomery GI Bill)
Chapter 30 (Active Duty)
Chapter 31 (Voc-Rehab)
Chapter 35 (Benefits for Children and Spouse)
Please certify my enrollment for:
*
Please select
Fall 2022
Spring 2022
Number of credits I am enrolled for
*
Other benefits you are planning to use this semester
*
EAP
MFEP
Federal Tuition Assistance (FTA/TA)
ROTC
None
I agree that if I make any changes to my schedule (increasing or decreasing credits), I will immediately notify the Veteran Services Office of such changes as they may impact my GI Bill Education Benefits.
I also agree that the credits I am enrolled in and asking to be certified to the VA Office are all requirements for my intended major.
Electronic Signature
*
By typing your name in the Electronic Signature box above, you are confirming you are the student listed above. You authorize Penn West Clarion to certify your enrollment to the VA Office.
Today's Date
*
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/
DD
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YYYY
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