VA Semester Worksheet Form

VA SEMESTER WORKSHEET FORM

This form must be filled out for each term of enrollment. Failure to complete this form fully will cause a delay in processing your enrollment verification & monthly GI benefits.
Term*
EMPL ID*
Enter 0 if you are unsure
Name*

First NameLast Name
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Email*
example@example.com
Phone Number*
Please enter a valid phone number.Format: (000) 000-0000.
I consent to the release to the US Department of Veterans Affairs all of my education records maintained by Dakota College at Bottineau, including my Social Security Number to allow me to receive VA Educational Benefits.*
Are you a:*
What Benefit Chapter are you using?*
What % do you qualify for your Benefit? (Enter 0 if you don't know)*
Remaining months of benefits? (Enter 0 if you don't know)*
Are you using TA in addition to the GI Bill?*

Major of Study*
Are you a:*
If this is your first term transferring to Dakota College you are required to complete additional paperwork at this link. If you need additional information please contact your military office.
Number of Credits enrolled in this semester?*
Changes made to your schedule after submitting this form need to be reported to Misty Lindgren (misty.lindgren@dakotacollege.edu) Your changes may create a debt for you that will require repayment of VA educational benefits you may have already received (book stipend, housing, tuition and fees)
Are you repeating any classes?*
List repeated courses:*
Are you taking collaborative courses?*
List of collaborative courses?*
Are you using tuition waivers?*
List waivers:*
Are you receiving scholarships?*
List of scholarships you are receiving*
Your instructor will be contacted if you receive a failing grade. It is important to understand that the VA pays you for attending class, not just registering for the course(s)*

Agree
The VA WILL NOT pay for repeated courses (unless the course you are repeating requires a higher grade than you received initially).*

Agree
The VA WILL NOT PAY FOR AUDITED COURSES*

Agree
Chapter 30, 35, 1606, 1607 recipients must verify their enrollment monthly.*

Agree
FAILURE TO NOTIFY DAKOTA COLLEGE OF ANY CHANGES TO MY SCHEDULE MAY RESULT IN AN OVERPAYMENT OF BENEFITS WHICH I WILL BE RESPONSIBLE TO PAY BACK TO THE VA.*

Agree
Complete the Captcha*
Signature

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VA SEMESTER WORKSHEET FORM