First Name *

Plese enter you first name

Last Name *

Please enter your last name

JNumber *

RequiredFieldValidator

Address *

Please Enter a valid address

Email *

Please Enter a valid Email Address

Phone Number *
RequiredFieldValidator

Select the Chapter authorizing your GI Bill® benefits.

Chapter 30- Montgomery GI Bill ™(Active Duty)

Chapter 31- Vocational Rehabilitation Benefits

Chapter 33- Post-9/11 GI Bill ™

Chapter 35- Survivors and Dependents Assistance

Chapter- 1606 Montgomery GI Bill ™-SR

Date of Birth (mm/dd/yyyy) *

RequiredFieldValidator

(Current Service Members Only) Do you plan to use Federal Tuition Assistance in addition to your VA Education Benefit? *

Yes

No

RequiredFieldValidator
If yes, please list the Class Name and Course Number. Ex. Class Name: Media Programming, Class Number: MC 440

Have you previously used this VA benefit? Note: If no, you must apply with VA to use benefits. *

Yes

No

I am requesting certification for all terms and intercessions. *

Fall 2023
Spring 2024
Summer 2024
Fall 2024

Have you attended JSU before? *

Yes

No

If yes, last term/year attended.
RequiredFieldValidator

Will you be residing in on campus housing? *

Yes

No

Are you registered for an externship, internship or clinical course? *

Yes

No

Total Number of Hours
RequiredFieldValidator

My Program of Study is: *

Undergraduate

Graduate

Doctoral

Current Degree/Major (i.e. Business Administration, Civil Engineering, or Social Work, etc.)* *
RequiredFieldValidator

Expected Graduation Date *
RequiredFieldValidator

Document Upload (Adobe PDF or JPG only)

* In leiu of your signature, please check this box and type your full name below.

Attention: Veterans & Current Service Members, for Health & PE exemption, you must submit your DD Form 214 (Separation Papers) and Military Transcript to jsuveterans@jsums.edu.

CERTIFICATION POLICY FOR VA EDUCATIONAL BENEFITS

The focus of the VA Program is to serve in a role that enhances the military friendliness of the institution by providing VA Educational Benefits to Veterans and Eligible Dependents while abiding by the federal requirements set forth by the Department of Veteran Affairs. These requirements, and the resulting policy, serve to enhance graduation rates and equip veterans for employment opportunities by providing the credentialing of a college degree. These policies are geared towards optimizing timely Program Completion and the continued progression towards higher educational goals.

1. Jackson State University DOES NOT participate in advance payments.

2. This institution certifies one semester at a time and each semester the veteran must notify the VA Certifying Official of any classes being taken which need to be certified.

3. The VA Certifying Official will only certify classes that are in your program of study.

4. The VA Certifying Official will only certify classes that are needed for graduation requirements.

a) i.e. – If you have completed a required area on your degree audit, once the VA Certifying Official is aware that this requirement is met, other classes that fall within your major but that do not contribute toward advancing progress towards your graduation requirements will not be certified.

b) “Rounding Out” the final semester is an exception to the previous item.

c) The VA Certifying Official reserves the right to correct any certification that has been certified in a manner that does not meet VA or State Approving Agency guidelines.

5. It is the STUDENT’s responsibility to notify the VA Certifying Official of any changes in the STUDENT’s schedule ASAP!

a) The VA Certifying Official has to report changes within 30 days of the change in status.

b) Withdrawals can negatively affect the continuance of receiving VA educational benefits

c) If there are mitigating circumstances surrounding a withdrawal, please notify the VA School Certifying Official of these circumstances. Documentation will be required.

d) To notify the VA Certifying Official each semester of his or her intent to use the benefits for the upcoming semester.

e) To submit all scholarship information to the VA Certifying Official.

f) If the STUDENT drops a course without notifying us verbally or in writing, the STUDENT will incur a debt that must be paid back to the Department of Veterans Affairs.

g) If the STUDENT withdraws from a course that has been certified, it is at the VA’s discretion to temporarily suspend payments at which time the STUDENT will need to provide information to the VA in order to reactivate their educational benefits.

h) If the STUDENT changes majors or transfers from another institution, or to another institution, the STUDENT should notify the VA Certifying Official ASAP and fill out a “Request for Change of Program or Place of Training” form to the Department of Veterans Affairs in order to keep receiving VA Educational Benefits. JSU’s “Change of Major” form must be submitted to the Registrar's Office. VA Form 22-1995 is for Service Members and Ch. 33 Post 9/11 recipients. VA Form 22-5495 is for Ch. 35 DEA recipients (Dependents’ Request for Change of Program or Place of Training).

i) JSU will certify “Guest STUDENTS once there is an active consortium agreement between schools and the classes have been confirmed to go towards the program at the home institution.

j) JSU requires a Military (Joint Services) Transcript, an Air Force Community College Transcript, and a Certificate of Eligibility for certification. (On occasion, a Certificate of Eligibility may be provided after the initial certification since the certification generates a new Certificate of Eligibility, but a copy of the submitted application needs to be provided. This is per guidance received by the VA.)

PLEASE NOTE: VA FILES ARE CHECKED REGULARLY IN ACCORDANCE WITH THE STATE APPROVING AGENCY!

By PROVIDING MY NAME AND J NUMBER below, I acknowledge my responsibilities listed above concerning the VA Benefits I am receiving and understand that failure to comply with these requirements can result in debts created by VA, and that these debts have the potential to affect my JSU STUDENT account as well.

Please type

Full Name and J number for Signature
Signature

Veterans Intake Form