Cuyamaca College Veteran Services
Fall 2012 Semester Intent Form
Name:
Last
First
Social Security #
Address:
Student ID #
Number
Street
City
State
Apt#
Is this a new address? Yes
No
(If yes, please fill out an address change form)
Zip
Evening Phone Number
Phone Number
Chapter #
M.I.
Chapter 33: Eligibility %
Are you active duty?
Are you a dependent?
Major at Cuyamaca College:
Is this a change of major? Yes
No
How many units are you taking during this semester?
Have you received Veteran benefits at Cuyamaca College before?
Yes
No
If yes, semester of last attendance:
Will you be attending another college concurrently? Yes
If yes, you must submit a copy of you registration statement.
No
Have you attended any other colleges or universities?
I understand that this form and all necessary documents must be submitted to the Veterans Services Office 5 business days before the
semester begins to ensure that the enrollment is submitted to the Department of Veterans Affairs with minimal delays. It is also my
responsibility to notify Veterans Services Office of any changes to my course schedule and this may result in a debt to repay the
Department of Veterans Affairs.
Signature X
Date Received
By:
Date entered on (Colleague):
Comments:
Revised 7/09/12
Date Signed
Office Use Only
Chapter # 30 31 33 35 1606 1607
Date sent to Veterans Affairs: