VA Benefits Election Form

Students who wish to use VA Education Benefits for the upcoming semester at Kentucky Wesleyan College must complete this form. Completion of this form authorizes the School Certifying Official to certify your enrollment with the U.S. Department of Veteran Affairs, and this form should be completed each term the student wishes to use their VA benefits.

First Name

Middle Name

Last Name

Email Address

Birthdate

Student ID

Major

Academic Level

Undergraduate

Graduate

What term are you wanting to use your VA Benefit?

What VA Benefit are you electing to use?

Other VA Benefit

Are you a first-time or continuing user for VA Benefits at Kentucky Wesleyan College?

First-time

Continuing

Please attach Certificate of Eligibility (COE)

Please attach DD-214 (if applicable)

Yellow Ribbon Program

Our institution participates in the Yellow Ribbon Program, which may provide additional funding towards tuition and fees that exceed the Post-9/11 GI Bill Maximum. Students wishing to be considered must be at 100% eligibility at the benefit level. If approved for Yellow Ribbon, the institution and the VA will each contribute a portion of the remaining tuition and eligible fees balance.

Would you like to be considered for the Yellow Ribbon Program?

Yes

Please sign for the following acknowledgements:

I understand the VA will only pay for courses that apply to my declared degree program. I understand that adding, dropping, or withdrawing from classes may affect my VA benefits and may result in a debt to the VA. I agree to notify the School Certifying Official immediately if my enrollment changes. I understand that certification will not be processed until I am registered for courses. I understand that submitting this form authorizes the institution to certify my enrollment to the VA. I understand that I am responsible for any charges not covered by VA benefits, including fees, housing, or charges exceeding my benefit eligibility. I certify that the information provided is accurate and that I request the School Certifying Official to certify my enrollment with the Department of Veterans Affairs.

Click to Sign...