VETERANS QUARTERLY ENROLLMENT FORM (Please read, print clearly and fill out the form completely)

Name (Last, First, Middle Initial) Email Address:

Address: (complete only if your address has changed) Is this an address change? Yes No

City, State, Zip Home/Cell Phone:

Current Degree Plan:

Have you changed your degree plan since your last certification?

If yes, what degree?

Yes No

VA Chapter 30 (MGIB) 33 (POST 9/11) 31 (VOC REHAB) 35 (DEPENDENT)

1606 (RESERVE) 1607 (REAP) 33 (TRANSFERABILITY)

***Your initials will confirm that you have read and understand each item***

INITIALS I understand that after I register for my courses each quarter I must • Notify the Certifying Official of any changes immediately• Communicate if a problem may hinder you from taking/completing classes

INITIALS I understand that if I take MATH (075,085, or 095)/ ENGL096 online, the VA will not pay for those classes. It must be taken in person only

INITIALS I understand that I should meet/communicate with the VA Academic Advisor before each quarter or when applicable.

What quarter are you registering for? Summer Fall Winter Spring

INITIALS I understand that the courses listed above are part of my degree plan. I understand If they are not, my certification will not be sent to the Department of Veterans Affairs.

Student Signature: Date:

Student ID Number:

Cascadia College is an equal opportunity institution and does not discriminate on the basis of race, color, religion, gender and/or sex, disability, national origin, citizenship status, age, sexual orientation, veteran’s status, or genetic information. All Cascadia materials are available in

alternative formats and can be requested by contacting the Human Resources office.

Course Number e.g. ENGL101 In-Person/Online/Remedial Credits

AI 10/2019