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Cowley College
Office of Veterans' Service

Request for Certification Form

Contact the Registrar's Office for more information.
Phone: 620.441.5595
Fax: 620.441.5250
Email: veterans@cowley.edu

YOU MUST HAVE ENROLLED IN CLASSES FOR THE APPROPRIATE SEMESTER BEFORE COMPLETING THIS FORM.

Personal Information - This must be completed each semester. Omitted information may delay processing. Files will be processed on a "first-in, first-out" basis.

 

First Name


Last Name
E-mail Address
Phone Number
Street Address
Apt
PO Box
City
State
Zip
Is this an address change from what is on file with the Veteran's Administration?
 
VA Claim #
(Chapt. 35 only)
Social Security #
Cowley ID #
Benefit Chapter - Please select your benefit chapter (only one).
 
 
 
  Post 9/11 Veterans Educational Assistance (Chapter 33)
  Veteran
 

Spouse/Dependent

 
 
 
Have you used your education benefits before?
 
If Cowley College is not your parent school where you will be getting your degree, what school is your parent school?
 
If Cowley College is not your parent school, enter the name and e-mail address of the certifying official.
Enter Name
Enter Email


Have you submitted a Change of Program/Place of Training (form 22-1995) to the VA changing your parent school to CCCC?
  Yes No
Have you requested the above academic transcripts from your previous school?
  Yes No
List all post-secondary schools you've attended.
School City, State Approx. Hrs.
Current Status:  
Semester
Number of hours enrolled
Major
Degree
By pressing the submit button you are certifying that all the information is complete and correct.
 

Please click the submit button only once. It may take a few minutes for a confirmation message to appear.


 
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