TAMU-CC Office of Veterans Affairs

6300 Ocean Drive, Corpus Christi, Texas 78412   361-825-2331     Fax 361-825-5887

VETERAN  INTENT  TO  ENROLL

 

Name _____________________________________________________________

 

SSN# ________________________         VA Claim # (Ch 35) ______________

 

Address ____________________________________________________________

                   Number                                                                  City, State                                              Zip

Telephone

Home # _______________ Work # _______________  Cell # _______________

 

E-mail address ______________________________  DOB __________________

 

VA Educational Benefit:

 

            _____ Chapter 30 - Montgomery GI Bill   Are you currently Active Duty (Y/N) ___

 

            _____ Chapter 32- Veteran’s Educational Assistance Program (VEAP)

 

            _____ Chapter 35 – Dependents Educational Assistance (DEA)

 

            _____ Chapter 1606 – Montgomery GI Bill – Selected Reserve

 

            _____ Chapter 1607 – Reservists called to Active Duty

 

Degree Objective:      _____ Graduate (Masters)                _____ Undergraduate

 

                                    _____ Graduate (Doctoral)              _____ Certification

 

Major ________________________  Is this a change of major? _________________________

 

Note:  A degree plan for current major must be on file.  VA Form 22-1995 or 22-5495 must be

submitted for a change of program or place of training.

Semester of Intent: Fall             _______ (Indicate Year)        Number of Hours ______
                             Spring          _______                                                          ______
                             Maymester   _______                                                           ______
                             Summer I    _______                                                            ______
                             Summer II   _______                                                            ______

Note:  The VA office must be notified of any changes to the number of hours specified on this form

(added/dropped) and the Intent to Enroll form must be submitted each semester prior to certification.

 

I intend to pursue the specified class load and request certification for the period indicated above.

 

Signature: _________________________________           Date: _______________________