Request for benefits-fillable

Request for benefits-fillable - REQUIRED by your program of...

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Return East Carolina University Office of Veteran Affairs 101 Whichard Building Greenville, NC 27858 Phone: 252-328-1731 Fax: 252-328-4232 POC: Connie S. Blake regis@ecu.edu blakec@ecu.edu Full Name: (first) (middle) (last) Phone: *ECU email address: @ students.ecu.edu Date of Birth: ECU ID: B Chapter Are you the Veteran Dependent Indicate the approximate number of hours you plan to attend for each semester you want to receive MGI bill payments. Any necessary adjustments to the original certification will be made after the last day of drop/add; however, if your enrollment changes at any time during the semester, IT IS YOUR RESPONSIBILITY to notify this office in order to avoid a possible overpayment . Spring 2012 hrs.** 1 st Summer 2011 hrs. 2nd Summer 2011 hrs.** Request for Retro terms of 11 Week 2011 hrs **Are you graduating during one of these terms? Fall 2011 hrs.** Yes No TERM: Current Degree and Major Program: Please indicate your minor or area of concentration: (if
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Unformatted text preview: REQUIRED by your program of study) Do you want advance pay for fall term? Yes No Our office must receive your request for advance pay no later than 30 business days before the term begins. ***Chapter 33 does not qualify for Advance Pay! I am receiving additional monetary benefits from the following sources: (failure to report such benefits may result in an overpayment of VA benefits) Tuition Assistance Top UP Tuition Only Scholarships Tuition Only Grants Other Explain: Your signature is required on this form. Unsigned requests will not be processed. Signature: Date: * Your ECU email address will be submitted to the VA with your claim so that you can be notified of any activity concerning your certification. Our office also corresponds with you through your ECU email account. Please check your email account frequently . OFFICIAL OFFICE USE ONLY: DE Hours:_____ Tuition:__________________ Fees:____________________...
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