VA Benefits Request Form
This form must be completed each semester that you would like to use VA Education benefits. All courses reported to VA must be requirements of your degree program. Before we can certify your enrollment with the Department of Veterans Affairs, you must first apply for and receive your Certificate of Eligibility (COE). If you have not already done so, please email a copy of your COE to veterans@nmc.eduÂ
Name
*
First Name
Last Name
NMC ID
*
Email
*
example@example.com
Semester for VA Benefits - Choose only one semester after completing your registration. This is the semester you are requesting your enrollment be reported to VA for use of your VA Education Benefits.
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Summer 2026
Fall 2026
Spring 2027
Summer 2027
Previous semester not listed - please email veterans@nmc.edu with the prior semester
Which VA educational benefits are you using?
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Chapter 30 Montgomery
Chapter 31 Vocational Rehabilitation
Chapter 33 Post 9/11 (includes transfer CH 33 benefit)
Chapter 35 Survivor's and Dependent Educational Assistance Program
Chapter 1606 Select Reserve
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Chapter 31 Veteran Readiness and Employment (VR&E)
Case Manager's Name
*
Case Manager's Email
*
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Chapter 33 Post 9/11 (includes transfer CH 33 benefit)
I am a...
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Veteran
Dependent using transferred benefit
Eligibility
*
100%
90%
80%
70%
60%
50%
Unsure
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Chapter 35 Survivor's and Dependent Educational Assistance Program
Veteran's First & Last Name
*
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Statements of Understanding
Please confirm the following statements. These are required, and you will not be able to submit the form if they are not checked.
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I understand I must complete a separate form for EACH semester.
I understand that changes to my schedule could affect my VA benefits, and I could be responsible for repaying VA. VA repayment could include book stipend, monthly housing allowance, and/or tuition and fees payments.
I understand that only courses that apply toward my program can be certified for VA educational benefits. I understand that additional classes that do not apply toward my program cannot be certified for VA educational benefits.
I understand that all email correspondence must go through my NMC email address.
I understand that I am responsible for any tuition and fees not covered by my VA educational benefits and for making payment arrangements with NMC, as needed.
I understand that it is also my responsibility to know the rules and regulations of my VA Educational Benefit. If I have questions, I can contact the NMC School Certifying Official (veterans@nmc.edu) or the VA (888-442-4551 or gibill.va.gov).
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