LBCC - Veteran's Services

Personal Information

First Name: *

Last Name: *

LBCC ID#: *

Email: *

Home Address: *

City: *

State: *

Zip Code: *

Phone Number: *

Application Information

Certification Term: *

Degree Objective(s): *

Certificate

Associate Degree

Transfer to a 4-year University

To what institution do you intend on transferring?

California State University (CSU)

University of California (UC)

Private College

Out-of-State College

Other Destination

Other Degree

Major: *

Business

Computer Science

Nursing

Other Major

Do you plan on pursuing a double major? *

Yes No

Please indicate your secondary major/goal. The VA will only allow double majors when those majors are interrelated to a specific occupational career. Double majors/goals must be noted on your Educational Plan to be certified.

Second Major:

Do you have an Educational Plan on file? *

Yes No

Note: All students using benefits taking major required courses must have an updated Ed Plan on file to be certified.

Which VA Educational Benefit are you utilizing? *

Chapter 30 (Montgomery Bill)

Chapter 31 (Vocational Rehabilitation)

Chapter 33 (Post 9/11 GI Bill)

Chapter 35 (DEA-Dependents)

Chapter 1606 (MGIB Selected Reserves)

Are you requesting Advance Pay? *
Yes No

Have you started a file in the Veteran's Service Office? *

Yes No

Note: All students using benefits must start a physical file in the Veterans Service Office in order to be certified. Please visit the VSO at LAC campus in "E"08 ( lower level of the "E" bldg. ) as soon as possible to process your benefits.

Notes/Comments:

Agreements

Do you understand your responsibility to pay the student health fee and agree to pay it in a timely fashion (~3 Days)? Classes may be dropped for non-payment. *

Due to the time delay of VA payments, we recommend that all students pay their Student Health Fee within 3 days of enrollment. If a payment is not received in a timely fashion, LBCC has the right to drop students' courses

Yes, I understand my responsibility and agree to pay the Student Health Fee in a timely fashion

No, I will not pay the Student Health Fee in the near future and accept the responsibility of both the debt and the possibility of having my courses dropped

Have you read and agree to adhere to the Standard of Student Conduct *

Yes, I have read the Long Beach City College Standard of Student Conduct

No, I have not read and/nor agree agree to adhere to the Standard of Conduct but understand that there may be disciplinary consequences for my behavior on campus.

Signature

I certify that all information is complete and correct. I agree to inform The Veterans Service Office of any changes in my enrollment status (adding/dropping certified class). I understand that failure to do so may result in me owing a debt to the Veterans Administration

Signature: *

Date: *

* - Denotes required fields

Benefits Request Form