Military and Veteran Registration Certification Form

Personal Information

First Name*

Last Name*

Middle Initial

Cell Phone Number*

Home Phone Number

Email Address*

Confirm Email Address*

Suffolk ID #

Numbers only. Do not enter a # symbol.

Term *

Program of Study *

Military Status

Home Address

Street Address*

City*

State

Zip Code*

Country

Veterans Education Benefit(s)

Chapter 30

Chapter 30 - Montgomery GI Bill

Chapter 31

Chapter 31 - Veterans Readiness and Employment (VR&E)

Counselor Name

Chapter 33

Chapter 33 - Post 9/11 GI Bill

GI Bill® Percentage *

Transferred Benefit

YesNo

Guest Student

Guest Student ONLY

Home School

Must submit parent letter to veterans@sunysuffolk.edu

Chapter 35

Chapter 35 - Survivors and Dependents Educational Assistance

Veteran Parent SSN required (first semester only). Please call 631-451-4456.

Chapter 1606

Chapter 1606 - Montgomery GI Bill Selected Reserve - Reserve/National Guard

MY CAA

NYS Veteran Tuition Award

NYS Veteran Tuition Award - Veterans who deployed to combat zones

NYS MERIT Scholarship

NYS MERIT Scholarship - death of, or permanently and totally disabled veterans and their dependents

Military Education Benefit(s)

For students actively serving in the military.

Federal Tuition Assistance

Approved voucher must be submitted to the VRC.

Branch

Unit

Select all that apply:

ActiveGuardReserve

State Tuition Assistance

Division of Military and Naval Affairs (RIRP). Must submit application to NYS by August 15 for Fall and December 15 for Spring.

Branch

Unit

I am registered for the following number of credits and am requesting my charges to be deferred, pending the above benefit(s). *

Request for charges to be deferred for ___ credit(s) pending the following tentative award(s).

Student Promissory Note

Please read each statement and provide your initials below to confirm that you understand.

I accept tuition liability for all tuition, fees and other charges that result from my enrollment at the college. I have been advised that third party deferrals can be canceled by the college at any time. I accept a third party deferral in the amount of my Veterans benefits or Tuition Assistance listed above, and promise to pay this amount and any subsequent late payment or collection fees that result, if the third party does not pay the college.

Initials *

By typing my initials here, I have read the information above and agree to these terms.

Digital Signature

Please read each statement and provide your initials below to confirm that you understand.

My education benefits will not be awarded for courses that are not counting towards my degree.

I understand that if I fail to attend a class or withdraw, my tuition will not be paid and I will be financially responsible for any debt incurred to the school as well as the VA or military branch. (This includes W-withdrawal, FN-failure for non-attendance, UN- Unsatisfactory progress for non-attendance, or NA-not attending grades.)

It is my responsibility to pay any and all tuition and fees due to SCCC, minus anticipated education benefit payments made directly to the school, by the payment deadline or I may be dropped from my classes.

I understand that in order to receive my full housing allowance, I am required to be registered full time and have at least one course that meets fully on-campus. (Post 9/11 GI Bill® and VR&E users only.)

I understand that if I am using the Post 9/11 GI Bill® or the Chapter 1606 Select Reserve Montgomery GI Bill, or the Chapter 35 Survivor's and Dependents Educational Assistance benefit, I must verify attendance with the VA starting with the last day of the month, or my benefits will not be paid.

Note: For more information on how to verify your enrollment with the VA, please call 1-888-442-4551 or visit https://benefits.va.gov/gibill/isaksonroe/verification_of_enrollment.asp.

Signature*

By typing my full name below, I have read the information above and agree to these terms.

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Enrolling and Admissions

If you are planning to use Military or Veterans education benefits, please complete the form below EACH SEMESTER so that your benefits can be certified.