Please complete the following information: Semester (Fill out one

Buffalo State, Veteran and Military Services, Cleveland Hall 210, 1300 Elmwood Ave, Buffalo, NY 14222, Phone: 716-878-5907, Fax: 716-878-5930
Please complete the following information:
Semester (Fill out one form for each semester): 20______J-Term
20______Spring
Name: ________________________________________________________________________________________
Last
First
20______Summer
Phone #: ___________________________________
M.
Address: _____________________________________________________________________________________________
Street
20______Fall
City
State
DOB: ________________________________
Zip
Email: ________________________________________________________________________________________________ SSN: _________________________________
Banner: B______________________________
Ch. 31/35 File#________________________________________
Are you still on Active Duty: _______Yes
_______No
Are you out of State: _______ Yes
Ch.35Payee#:__________________
If yes, when is your separation Date? _________________________________
_______ No
1. How did you hear about Buffalo State College: _________________________________________________________________________________________
2. Branch: ______Army
______Air Force
3. Component: ______Active
______USMC
______Reserve
______Navy
______Coast Guard
______ Dependent (Spouse/Child)
______National Guard
4. Current Status: ______Undergraduate ______Graduate
5. Has your Major changed since last semester:
______Yes
_____No
6. Have you used VA benefits before:
______Yes
_____No
7. Are you a transfer student this semester:
______Yes
_____No
8. Is this your first semester at Buffalo State:
______Yes
_____No
9. Are you a Guest Student at BSC this semester:
______Yes
_____No
10. Are you a Guest Student at another college this semester:
______Yes
_____No
11. Chapter:
______ 1606 MGIB (SR)
______ 35DEA






______ 30MGIB
______ 33 Post 9-11
______ 31Voc. Rehab
______ 33 Dependent
______ No GI Benefits Parking Permit Only
Name of Institution________________
______ 1607REAP
______ 35 Champ.VA
STATEMENT OF UNDERSTANDING
I hereby agree to notify the Buffalo State College Veteran’s Certification Office immediately via email or letter of any changes in
my status including: a) change in registered credit hours; b) withdrawal from course or college; c) change of major; d) change
of address; etc… Note: Changes in registered hours may adversely affect my benefits.
I hereby certify that no changes have been made to my status in previous semesters via academic petitions, late submission of leave of
absence, etc… that may affect past payment of benefits from the VA.
VA educational benefits cannot be paid to non-matriculated college or university students unless they are pending admission to your
school. In that case they can be certified for two quarters or semesters. The student can be certified beyond this two-term limit only if
the student is admitted to your school as a degree-seeking student, irrespective of the number of credits taken. Failure to comply may
results in suspension of benefits.
THIS FORM MUST BE COMPLETED AND TURNED IN NO LATER THAN THE BEGINNING OF EACH SEMESTER OF ATTENDANCE
THAT YOU WISH TO RECEIVE BENEFTIS FOR. Failure to comply with the above may adversely affect processing payment of your
benefits.
My VA benefits will be discontinued if there is a failure to maintain satisfactory academic progress and attendance toward my approved
degree program. I have approximately nine weeks to complete any incomplete grades from the previous semester.
I am responsible for paying any charges to Buffalo State not covered by VA benefits.
_____________________________________________________________________________________
Signature
Nov 2014 - GI BILL School Attendance Form
_______________________________________
Date
Buffalo State, Veteran and Military Services, Cleveland Hall 210, 1300 Elmwood Ave, Buffalo, NY 14222, Phone: 716-878-5907, Fax: 716-878-5930
FOR OFFICIAL USE ONLY
DATES CHECKED CLASS REGISTRATION
Total Credits:
Res:
Dist:
R/D:
Major:
Undergrad or Graduate Student:
NY Resident: Yes
No
SGASTDN:
T & F:
Add to Net T&F Spreadsheet (Ch. 33 only):
FOR OFFICIAL USE ONLY
Orientation Fee:
Ch. 31 Memo:
VAONCE:
Parking Roster:
Guest Student (Primary School Letter):
Guest Student (Secondary School Letter):
ADDITIONAL REMARK
Nov 2014 - GI BILL School Attendance Form