Certification Agreement

Status/Term (check all that apply):*

Veteran

Dependent

Winter/Spring

Summer/Fall

Name:*

SMC Student ID:*

Phone:

Address:

City:

State:

Zip Code:

SMC Email:*

For Veterans - required

VA Claim #/Veteran:

For Dependents - all three required

VA Claim #/Veteran:

VA Claim #/Dependent:

Suffix #:

First Term/Year Attended SMC:

Units Completed:

Units in Progress:

SMC Educational Goal:

Major (Area of Emphasis):

Transfer School:

Name all school(s) attended other than SMC (include units completed, Degree Earned and if there is a Transcript on File):

Please check benefit eligibility/branch of service (funding under the G.I. Bill or other V.A. approved program):*

If "Other" please specify:

Branch of Service:*

VA Benefits/Courses Requested

Please list the Semester/Year, Course Name, and Units

Course 1:*

Course 2:

Course 3:

Course 4:

Course 5:

Total number of Units:

Read and Initial

I understand it is my responsibility to submit documentation for benefits to the Santa Monica College Veterans Resource Center.

I understand it is my responsibility to complete this form EVERY term, with my original signature, if I want to receive benefits after registering for classes.

I understand that the VA will only pay for courses that are required for my degree.

I understand that I will be financially liable for payment of tuition and fees not covered by the VA.

I understand that I am liable for any overpayment, discrepancies or delays in receipt of my benefits.

I am not repeating any course for which I have received college credit ('D' grade or better)

I understand that I am responsible for notifying the Santa Monica College Veterans Resource Center within three school days of any change in my class schedule (adding or dropping).

I agree to the statements above (Please Initial):*

By checking this box, I authorized that the answers given are true and correct:*

yes

Certification Agreement

Certification Agreement Information.