FALL 2015
VA STUDENT ENROLLMENT PACKET
 INSTRUCTIONS: READ CAREFULLY, COMPLETE EACH SECTION, AND SIGN.
 COMPLETED FALL 2015 VA ENROLLMENT PACKET SHOULD BE SUBMITTED TO
HARFORD’S MILITARY & VETERAN SERVICES OFFICE AT APG OR THE
FINANCIAL AID OFFICE AT HCC FOR PROCESSING.
 CERTIFICATIONS WILL BE COMPLETED IN THE ORDER THEY ARE
RECEIVED. TO EXPIDITE THIS PROCESS PLEASE ATTACH A COPY OF
YOUR CERTIFICATE OF ELIGIBILITY AND YOUR DD-214 TO THIS PACKET.
IMPORTANT PLEASE NOTE: EACH QUESTION MUST BE ANSWERED &
INITIALED- INCOMPLETE VA ENROLLMENT PACKETS WILL NOT BE
PROCESSED, THEY WILL BE RETURNED TO THE STUDENT FOR
COMPLETION
 CHECK YOUR OWLMAIL FREQUENTLY FOR CORRESPONDENCE FROM HARFORD’S MILITARY &
VETERAN SERVICES OFFICE
 CONTACT INFORMATION HARFORD COMMUNITY COLLEGE MILITARY & VETERAN SERVICES OFFICE:
OFFICE LOCATIONS:
 HARFORD COMMUNITY COLLEGE, STUDENT SERVICES CENTER
 ABERDEEN PROVING GROUND OFFICE, BLDG. 4305, RM. 207, APG, MD
VA SCHOOL CERTIFYING OFFICIAL
JANICE CASSADY, COORDINATOR FOR MILITARY & VETERAN SERVICES
TELEPHONE NUMBER: 443-412-2612
JCASSADY@HARFORD.EDU
VA ADMINISTRATIVE ASSISTANT
TAMMY DENNIS, ASSOCIATE FOR MILITARY & VETERAN SERVICES
TELEPHONE NUMBER: 443-412-2100
TDENNIS@HARFORD.EDU
FAX NUMBER: 410-272-0669
FOR MORE INFORMATION, VISIT OUR WEBSITE AT www.harford.edu/military
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OFFICE USE ONLY
DATE PACKET
RECEIVED: ________________
RECEIVED BY:__________________
FALL 2015 VA ENROLLMENT & BENEFITS AGREEMENT FORM
EACH OF THE FOLLOWING QUESTIONS ON PAGES 1-4 MUST BE ANSWERED AND THE COMPLETED FORM
RETURNED TO THE MILITARY & VETERAN SERVICES OFFICE FOR CERTIFICATION PROCESSING
Last Name: _________________________________ First Name: ________________________________
Harford ID #: ________________________________ SS#: _____________________________________
Address: ________________________________________________________________________________
Street
City
State
Zip Code
Is Your State of Residence Maryland?_____ If Not, List Your State of Residency: ______________________
Telephone Number:_____________________________ Alternate Number:___________________________
Please check all that apply:
_____
_____
_____
_____
_____
Chapter 30 – M GI Bill
Chapter 31 – Voc/Rehab
Chapter 33 – Post 9/11
Chapter 1606 - Reservist.
Receiving a PELL Grant
_____
_____
_____
_____
_____
Chapter 1607 – R.E.A.P
Chapter 35 – Dependent Education Assistance
TA – Tuition Assistance
Other – List Program Name:___________________
Receiving a Scholarship: List Name of Scholarship
__________________________________________
_____ I AM REQUESTING CERTIFICATION FOR VA EDUCATIONAL BENEFITS FOR A SEMESTER THAT IS DIFFERENT
THAN THE ONE LISTED ABOVE. I AM REQUESTING CERTIFICATION FOR THE FOLLOWING SEMESTER(S):
SEMESTER:______________ YEAR: ___________
Check ONE of the following:
_____
I am a NEW STUDENT and have NEVER USED my VA Educational Benefits
_____
I am a RETURNING STUDENT who has received VA Educational Benefits at THIIS SCHOOL in the
past.
___________Year previously attended
_____
I am a TRANSFER STUDENT. I used VA Educational Benefits at another College. List the names
of all previously attended colleges:
______________________________
_____________________________________
______________________________
_____________________________________
______________________________
_____________________________________
OFFICIAL College and Military Transcripts must be submitted to the Registration & Records Office
to be evaluated for transfer credit. All transcripts must be submitted for evaluation BEFORE THE
END of YOUR FIRST SEMESTER at Harford.
_____
I am a GUEST STUDENT who is taking courses at Harford concurrently with another College that is
my PARENT College. (ATTACH a Parent Letter from that institution when you submit this packet)
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NAME:_____________________________________ HCC ID#:___________________ DATE:___________
Read each statement and initial indicating that you understand the statement. If you need clarification
before submitting the forms, please contact the Military & Veteran Services office at 443-412-2100 or by
email at vetsmilitary@harford.edu :
THE FOLLOWING STATEMENTS APPLY TO ALL CHAPTERS
WHILE RECEIVING VA EDUCATION BENEFITS AT HARFORD COMMUNITY COLLEGE, I UNDERSTAND THAT:
_____ I must register for classes at Harford before submitting this VA Enrollment Packet.
_____ I must submit a copy of the ‘Letter of Eligibility’ or a Notice of Basic Eligibility (N.O.B.E.) that I received from the
VA office outlining my educational benefits. (If you were certified for VA Educational benefits last semester, you are not
required to submit this document again, unless your benefits have changes)
_____
I must submit a copy of my DD214.
_____
I must complete the VA enrollment packet each semester that I request VA Educational Benefits
_____ I must submit copies of ALL official transcripts from the Military and previous colleges I have attended to the
Registration and Records Office, by the end of the first semester of my enrollment at Harford. I realize that I will not be
certified for subsequent semesters until all transcripts are evaluated.
_____ It may take two weeks or longer for my enrollment forms to be processed and the certification to be submitted to
the VA Regional Office. I know that this will depend on when I submit my Completed VA Enrollment Packet to the
Certifying Official.
_____ I am RESPONSIBLE FOR & MUST NOTIFY the Certifying Official IMMEDIATELY, if I make any changes to my class
schedule BEFORE or DURING the semester I am registered for. I AM AWARE THAT FAILURE TO NOTIFY THE CERTIFYING
OFFICIAL CAN RESULT IN ADJUSTMENT DELAYS, WHICH CAN CAUSE AN OVERPAYMENT/DEBT WITH THE VA.
_____ It is MY RESPONSIBILITY to notify the Certifying Official if I decide that I DO NOT want to receive VA
Educational benefits for any semester that I am enrolled in.
_____ It is my responsibility to contact the Certifying Official if I am reactivated during the semester, and should I have
to withdraw from classes. I also know that I will need to submit a copy of my orders.
_____ It is my responsibility to meet with a VA Academic advisor and select a degree plan at the beginning of my first
semester at Harford. I will not be certified for enrollment until I have selected a degree plan.
_____ I can ONLY be paid for courses which are required for the degree I am seeking at Harford. If I am enrolled in
courses outside of my degree plan, the Certifying Official will not certify me for those credits.
_____
I will not receive payment for courses which I have not successfully completed (‘D’ or better for most programs)
_____ The VA Regional office will be notified if I receive one of the following course grades and as a result of these
grades I may incur a debt with the Veterans Administration
F - Failure to meet course requirements
W - Course withdrawal without a grade (VA Certifying Official must be notified)
IIncomplete (VA Certifying Official must be notified of the date the course will be completed)
K - Audit – not for credit (VA Certifying Official must be notified)
_____ I can only be certified for courses that number below 100, if the Skills Assessment Test indicates that these
courses are required.
_____ Harford is not involved in the calculation of my VA educational benefit amount, other than certifying the correct
number of semester hours I am enrolled in each semester.
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_____
I am responsible for payment of any portion of the tuition, fees, and books not covered my VA benefits.
_____ I have received information on alternative methods of tuition payment (attached to this packet is information on
alternative methods of payment. This information is for you to keep and should not be returned with your enrollment
forms)
_____ Twelve credits during the Spring and Fall semester is equivalent to full-time enrollment, and I must remain
enrolled in 12 credits for the entire 15 weeks of the semester to maintain full-time status. I further know that the Summer &
Winter sessions are calculated by the VA Regional office and that they are based on a semester hour equivalency
(website for VA conversion tool: http://department-of-veterans-affairs.github.io/gi-bill-comparison-tool/)
_____ The Certifying Official has the authority to release information and documents to the Veterans Administration, as
they pertain to my educational benefits and academic progress at Harford.
_____ It is my responsibility to stay informed, through the Regional Veterans Administration Office, regarding specific
requirement for educational benefits. (website: www.va.gov)
THE FOLLOWING STATEMENT APPLIES TO CH 30, CH 1606, & 1607
_____ I must verify my enrollment on the last day of every month to the Department of Veteran Affairs in order to
receive my monthly benefit check. (Student can go online to www.gibill.va.gov and click the WAVE link, or they can call 1877-823-2378).
THE FOLLOWING STATEMENTS APPLY TO CH 30
_____
I am responsible for making the payment of my tuition and fees directly to Harford.
_____
I will be dropped from my classes if payment is not received by the tuition due date.
_____
My education benefits are sent directly to me by the Department of Veteran Affairs.
THE FOLLOWING STATEMENTS APPLY TO CH 33
_____ Tuition and fees are paid directly by the VA to Harford at the In-State rate only and that I will be responsible for
any out of state difference, and if I am not receiving 100% of the educational benefits I will be responsible for the
remainder of the tuition and fees.
.
_____ My book stipend is sent directly from the VA Regional office to me and that it may not arrive until after classes
have started, depending on when I registered and submit my forms to the Certifying Official.
_____ I must be enrolled in at least 7 credit hours, with at least one of those credits in a face-to-face format, for a 15
week semester to receive Basic Allowance for Housing (BAH). Hybrid classes are considered online classes by the VA.
(website for VA conversion tool: http://department-of-veterans-affairs.github.io/gi-bill-comparison-tool/)
_____ In order for the Certifying Official to put a hold on my account so that I will not be dropped for non-payment, I must
submit my completed VA Enrollment Packed at least 7 days prior to the drop date.
THE FOLLOWING STATEMENT APPLIES TO CH 35
___________________
is my VA File Number (This number is required in order to process your certification. Your
certification CANNOT be processed without this number. Normally, this is the last four of your parent’s social security
number.)
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I certify that I have read and understand the information contained in this Harford Community
College’s VA Enrollment & Benefits Agreement Packet.
I further understand that pages 1-4 must be COMPLETED ENTIRELY for my request for certification
under the Veterans Affairs Educational Benefits program to be considered by Harford. I realize that if I
submit an incomplete packet that the entire Enrollment Packet will be returned to me, and processing
of my certification for educational benefits will not begin until I submit a completed Enrollment Packet.
Print First and Last Name
___________________________________________________________
Student Signature
_______________________
Date
VA STUDENT FAILING GRADE POLICY
I (print your name here) ______________________________________________, understand and agree that
if I receive a failing (F) grade for one or more of my courses for any semester that I have been certified to
receive Educational benefits, I may be indebted to the Department of Veteran Affairs for the amount of benefits
I received for the course(s), depending on my last date of attendance. The VA Certifying School Official is
required to report last date of attendance for every course in which I made an ‘F’. If the Department of
Veterans Affairs warrants an overpayment based on my last date of attendance, I will receive a Notification of
Debt from the Department of Veteran Affairs and will be required to pay the amount owed on the notification. If
my absence from classes resulted in the failing grade and it was due to mitigating circumstances, it is MY
RESPONSIBILITY to notify the VA Certifying Official BEFORE the end of the semester regarding my situation.
I further understand that Harford Community College is in no way responsible for any debt owed to the Veteran
Affairs Office for any courses that I failed to complete successfully.
Print First and Last Name
___________________________________________________________
_______________________
Student Signature
Date
VA COURSE WITHDRAWALS AND DROPS
I (print your name here) ___________________________________________ understand and agree
that I must report any course withdrawals and/or drops to the VA Certifying School Official. The VA
Certifying College Official will notify the VA Regional office of any changes to my enrollment and
make the necessary enrollment adjustments to my VA certification accordingly to my changes in
enrollment.
Print First and Last Name
___________________________________________________________
_______________________
Student Signature
Date
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