First Name
Last Name
Student ID
Preferred Phone Number
Street Address
City
State
Zip
Are you a Massachusetts Resident?
Are you a dependent using VA benefits?
Student Email Address
Personal Email Address
Branch of Service
Other
Have you submitted proper documentation to receive qualified benefits? (DD-214, NOBE, VONAPP application, Certificate of Eligibility, etc)
Which semester are you wanting to be certified for?
How Many IN-RESIDENCE Credit Hours will you be taking? MOST classes are 3 credit hours (Please check each course to verify)
How Many ON-LINE Credit Hours will you be taking? MOST classes are 3 credit hours (Please check each course to verify)
How many TOTAL credits are you taking this semester? MOST classes are 3 credit hours (Check each course to verify)
What Educational Benefit are you planning to use?
If you are Chapter 33 (Post 9/11 G.I. Bill) What percentage are you certified for?* If you are not Chapter 33, please select N/A
Are you being charged out of state tuition and receiving 100% of your Post 9/11 GI Bill
Declared Major
Level of Study
What is your estimated graduation date? (ex. Spring 12, Fall, 12, etc...)