Military Services Verification of Enrollment Form - Mississippi Gulf Coast Community College

Has any information changed since your last certification?*
- Yes
- No
Date of Birth*
MM slash DD slash YYYY
Name*
First Last
Address*
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country
MGCCC ID (M) Number*
Last 4 digits of social security number*
MGCCC Email*
Enter Email Confirm Email
Daytime Phone*
Campus*
Military Status*
- Veteran
- Active
- Reserve
- Dependent
- Spouse
Branch of Service*
- Army
- National Guard
- Navy
- Air Force
- Marines
- Coast Guard
Note: Students using VA Benefits under chapter; 30,35, or 1606
Once your classes have been certified and submitted to the VA, The VA will send the benefit payment directly to you. Therefore, you will be responsible for paying MGCCC all tuition and fees associated with your account. In order to be sure to secure your classes, we would strongly suggest that you speak to the business office to set up payment arrangements while waiting to receive your payment from the VA.
VA Education Benefit Chapter Information*
Percent of Benefit*
VA File Number*
Student Status*
- New Incoming (1st time using VA benefits)
- Student Recertification (Returning Student)
- Transfer Student
- Guest Student
Transfer Student to MGCCC from*

School Name
NOTE: All transfer students must complete a Change of Place of Training Form (22-1995 or 22-5495) at https://www.va.gov/
Guest Student Parent School*

School Name
Program*
Area of Interest*
Program Type*
- Academic Program
- Career Technical Program
Level of Pursuit*
- Diploma
- Certificate
- Associate's Degree
Are you transferring to another college or university?*
- Yes
- No
Transferring from MGCCC to*

School Name
Term requesting to be certified:*
- Fall
- Spring
- Summer
Year requesting to be certified:*
Statement of Understanding
VA Regional Office submission*
I understand before my enrollment certification can be submitted to the VA Regional Office to begin benefits,
1. 1. I must have the following documents on file with the Admissions office:
  - - Application for admission
  - - All official college/school transcripts or high school equivalence diploma
  - - Official military transcript (service members)
2. 2. I must submit a Certificate of Eligibility (COE) to Military Services.
3. 3. I must submit a Verification of Enrollment (VOE) form to Military Services each semester to request certification.
Responsibility for charges*
I understand I will be responsible for all charges associated with courses that meet the conditions below.
1. 1. Courses not required for the current program of study and listed on the degree plan
2. 2. Courses previously passed with a "D" or better; exception, MGCCC programs that require a "C" or better for acceptance.
3. 3. Withdraw from a class after it is certified and/or class begin, this include all tuition and fees, basic housing allowance, and book stipend.
Responsibility to report changes*
I understand failure to report the following immediately may result in a debt for which I am responsible.
1. 1. Schedule changes (additions, withdrawals, term dates, audits etc.) to the Military Services Center).
2. 2. Scholarships received
Responsibility for advisement and document submission*
I understand that I must meet with an advisor every semester and submit all required documents to Military Services.
Email confirmation of certification*
I understand the VA will send a confirmation to my MGCCC student email once certification is complete.
Digital Signature*

Statement of Understanding