RaiderPortal: Veterans Enrollment Form

Lindsey Wilson University

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Veterans Enrollment Form

Complete this form every semester after you have signed up for classes. It is your responsibility to notify the VA Coordinator of any changes in your enrollment after this form has been submitted.

Student Information

First Name:

Last Name:

Address:

Phone:

Email:

Major:

***Note: If you change your major or you are transferring to Lindsey Wilson University; please submit a Request for Change of Program or Place of Training Form (there are two forms, one for service members - VA Form 22-1995 and the other for dependents - VA Form 22-5495). You can request these forms from the VA Coordinator or complete online at http://www.benefits.va.gov once logged in (make sure you let the VA Coordinator know that you completed the form online).

VA Information

Is the student requesting the benefits a Veteran of the United States Military?

YES

Social Security Number:

VA File # (Chapter 35 only):

Branch of Military (If you are a dependent, list branch for spouse or parent):

Chapter:

30 (Montgomery GI Bill)

31 (Voc Rehab)

33 (Post 9/11)

1606

1607

35 (Dependent)

Certification Information

Select the semester(s) you are requesting your VA benefit for:

Fall

Winter

Spring

Summer

Year:

Number of hours you will be taking: