GI Bill Enrollment Certification Request (ECR) Form

KAPI`OLANI COMMUNITY COLLEGE
KEKAULIKE INFORMATION & SERVICE CENTER (KISC)
4303 Diamond Head Road Iliahi Building, Room 117/118 Honolulu, HI 96816
Phone: 808.734.9555 Fax: 808.734.9896 Email: [email protected]
To prevent delays, please
submit this form before:
JUL 15th for FALL Term
DEC 15th for SPRING Term
APR15th for SUMMER Term
GI Bill Enrollment Certification Request (ECR) Form
NOTE:
Complete this application in its entirety. Failure to submit a complete application will delay the processing of your VA certification to
the Department of Veterans Affairs. In addition, if you have not done so, submit any appropriate documentation (i.e. COE, NOBE, DD-214, etc.).
KCC GI Bill Student Services will make every attempt to process VA certifications to VA within ten (10) business days of receipt of your request.
Student Information (Please Type or Print clearly)
Name (Last, First, Middle):
UH Student ID:
Phone Number:
UH Email Address:
Degree & Major Information
Degree and Major:
Concentration:
Select One :
New Student ( I have never used my VA Education Benefits and have not attended any university/college since high school)
Returning Student: Select One:
I have never used my VA Education Benefits
I have previously used my VA Education Benefits at KCC
Continuing (previously VA certified at KCC)
Transfer Student: Select One:
I have never used my VA Education Benefits
I have previously used my VA Education Benefits at*
(College/University's Name )
*MUST submit 22-5495 (Chapter 35 only) OR
22-1995 form (other Chapter)
Education Program Information
VETERANS ONLY:
Chapter 30: Montgomery GI Bill - Active Duty
Chapter 31: Vocational Rehabilitation Program
Chapter 1606: Montgomery GI Bill - Selected Reserve
Chapter 1607: Reserve Educational Assistance Program (REAP)
Veteran
Dependent
Chapter 33: Post-9/11 GI Bill Select One:
DEPENDENTS ONLY:
Chapter 35: Dependents' Educational Assistance (DEA)
VA File# or Claim#:
*Suffix#:
*VA assigns a suffix to the veteran's file number (e.g.: "10-W" for
spouse, "41-A" for the child who first used VA, "42-B" the child who's
next to use VA, etc.)
NOTE: If you don't know your Chapter number, please call VA Office at 1.888.442.4551
Academic Courses Information
TERM (Select One):
Fall
CAMPUS CODE:
KAP, LEE, HON, WIN, MAU
HAW,KAU, UHM, WOA, HIL
Spring
COURSE NAME
(Ex: ENG100, PSY100, etc)
Summer
NUMBER OF
CREDITS
STUDENT'S CERTIFICATION: I have reviewed my academic program
requirements with a counselor, and understand that I can be certified for VA
benefits for enrollment in required and prerequisite classes only. Although
enrolled for 12 or more credits in a given semester, I may not necessarily be
certified for full-time benefits for the entire semester if I am enrolled in
special term (modular) or prerequisite classes. I further acknowledge that it
is my responsibility to immediately report any changes to my schedule,
including add/drops to KISC VA GI Bill Office. Failure to do so may result
an overpayment of my benefits and an obligation on my part to repay that
overpayment.
Student's signature
Date
TO BE COMPLETED BY ACADEMIC COUNSELOR
Expected graduation semester/year ___ /___
Catalog Year _____
Is this a REQUIRED/PREREQUISITE/ELECTIVE course for the specific major
at KAPI'OLANI COMMUNITY COLLEGE?
YES, Applies as... OR
YES, its prerequisite for
NO
Check if
taken
before
with
letter grade
other than
"W"
COUNSELOR'S CERTIFICATION: I have reviewed this student's academic program
requirements and certify that the above information is accurate to the best of my knowledge
Signature of Counselor
Date
Email [email protected] Ext: ________
Received in KISC by: ________________ Date: ____________
09/11 AO
KAPI`OLANI COMMUNITY COLLEGE
KEKAULIKE INFORMATION & SERVICE CENTER (KISC)
4303 Diamond Head Road `Ilima Building, Room 102, Honolulu, HI 96816
Phone: 808.734.9555 Fax: 808.734.9896 Email: [email protected]
STUDENT INSTRUCTIONS:
1.
To be certified for veterans' benefits, the Department of Veterans Affairs must be informed of your previous college
course work or training.
a. Request official transcripts, including ACE transcripts, from all previous colleges to be sent to the Kekaulike
Information and Service Center (KISC). Submit the Transcript Evaluation Request form to the KISC. The evaluation
results will be sent to you approximately 6-8 weeks after ALL official transcripts, catalogs, and course descriptions
or syllabi (if applicable) are received by KISC. Bring the evaluation when consulting with your counselor.
b. Transcript evaluations will take approximately 6-8 weeks to complete, therefore, FOR YOUR FIRST TWO
SEMESTERS ONLY you may bring personal copies of your transcripts to your academic advising session or inform
your counselor of classes taken at other schools. Advising based on unofficial evaluation or your recollection of
courses taken may not be entirely accurate. If you are advised to take courses which are later found to be
repeats or are not certifiable, you may be required to repay the veterans benefits you received based on
incorrect or incomplete information.
c. An official transcript evaluation must be completed before you can be certified for VA benefits beyond your
second semester of enrollment. Therefore, it is recommended that you complete #1a above, as soon as possible
2. Schedule an appointment with a counselor for your current or intended major, if applicable.
Kapi'olani CC Current/Intended Major
Counselor
Location
Phone
Iliahi 118
734.9509
Email
VA Counselor
Flo Abara
Liberal Arts
Maida Kamber Center - Transfer, Graduation & Career Center at Ilima 104
[email protected]
Business, Legal & Technology: ACC, IT, MKT & LEGL
Melvin Jadulang (A - K)
Cynthia Kimura (L - Z)
Kopiko 111
Kopiko 109
734.9017
734.9107
[email protected]
[email protected]
Culinary Arts (Culinary Arts, Pastry Arts, Institutional Food Service)
Lori Maehara
Ohelo 121
734.9466
[email protected]
Health Sciences - Concentration in:
RESP, RAD, PTA, OTA, MLT, EMT, MICT, MEDA,DENT, BIOTECH, ESS
Russell Kinningham
Kauila 122
734.9270
[email protected]
Hotel & Restaurant Operations; Travel &Tourism
Sheryl Fuchino-Nishida
Olapa 121
734.9716
[email protected]
New Media Arts - Concentration in:
Animation, Interface Design, Information Architecture
Steve Harris
Ilima 104
734.9510
[email protected]
Nursing Education
Wes Maekawa
Crystalyn Hottenstein
Kopiko 201
734.9305
[email protected]
3. Bring this Academic Advising for VA GI Bill Education Benefits Certification form and results of your official transcript
evaluation (or unofficial copies of your transcripts if the official evaluation has not been completed) to your academic
advising session.
4. Submit the completed and signed form to your VA Certifying Official or KISC in `Ilima 102 after you register for class(es).
5. For Chapter 30, 35, 1606 &1607: Enrollment in Kapi`olani Community College classes for the semester/term will be
certified after tuition and fees are paid.
COUNSELOR INFORMATION
1. Transcript information:
a. If the student has been enrolled at KCC AND has had an official transcript evaluation, accepted transfer courses
will be recorded on STAR - Transfer Reports by Institution.
b. If an official transcript evaluation has been completed, but the student has not registered at KCC, the student will
bring transcript evaluation results (sent to the student from KISC).
c. If the student has not had an official transcript evaluation completed, he/she may bring personal copies of
transcripts or inform you of the classes taken at prior institutions.
2. Only REQUIRED courses will be certified. Recommended/Highly Recommended are not approved for VA certification.
3. Repeat courses are not approved for VA certification unless it fulfills the program requirement.
4. “Catalog year” refers to the year program requirements are listed in the specified catalog. Ensure that the proper year is
inserted.
5. Keep a copy of the completed Academic Advising for Veterans Benefits Certification form for your record.
ao 08/11