Request for Certification Form (West Bank and Jefferson)

Note: This form is intended for students of the West Bank Campus and the Jefferson Site.

If you are a student of online programs, the City Park Campus, the Charity School of Nursing, and the Sidney Collier Site, please submit the other request for certification form.

All Students

First name*

Last name*

LoLA number*

Social Security number*

VA file number

Address*

City*

State*

ZIP code*

Phone*

Email*

Alternate email

Primary major*

Secondary major

Student Status*

Are you using Louisiana National Guard tuition exemption?*

Are you using LA dependent's tuition and fee waiver certificate?*

Are you being charged non-resident fees?*

Please select the benefit you are using.*

Please select the semester you are applying for.*

Please provide any additional information you think we need.

Read each line carefully and provide your initials for each line. If the information doesn't apply to you, please enter "NA" for not applicable.

I understand that the VA counselor will contact me by email if there are any issues with my certification.*

I understand that I must allow at least 30 days for processing of my benefits.*

I understand that I must submit this form every semester to receive my benefits.*

I understand that only classes that are required for my degree or certificate can be used for my benefits (including prerequisites, developmental classes and course substitutions). I understand that I may be asked to verify classes.*

I understand that dropping or changing my schedule can result in a debt to the VA.*

I understand that it is my responsibility to ensure that my class schedule has been secured, and my classes will be dropped if I do not make payment arrangements by the payment deadlines listed in the student handbook.*

I understand that the VA does not allow developmental classes (ENGL 098/099, READ 071/072, MATH 092/098/099) to be taken as an online class or a hybrid class.*

I understand that General Studies and Louisiana Transfer degree majors are required to submit a degree plan every semester, but failure to do so may cause my certification to be delayed or not submitted.*

I understand that students using Ch. 30., Ch. 1606 and REAP benefits must verify attendance each month to receive their payments, and I can verify by calling 1-877-823-2378 or visiting www.va.gov.*

Post 9/11 GI Bill Students

The following section pertains to Post 9/11 GI Bill students only. If this does not apply to you, please enter "NA" for not applicable.

I understand that I am responsible or my tuition and fees at Delgado if my Post 9/11 GI Bill fails to come in for any reason.*

I understand that the Post 9/11 GI Bill Does not cover non-resident fees, and I must submit a Veteran/Service Member/Dependent/Spouse Non-Resident Tuition Waiver Request Form to the Admissions office to adjust this.*

I understand that a half-time schedule (6 credits for Spring/Fall, 3 credits for Summer) or less will make me ineligible for a monthly housing allowance.*

I understand that taking all online and/or hybrid classes will result in receiving half of the national average for my monthly housing allowance, and I must be enrolled in at least one traditional face to face course to avoid this.*

I understand that any refunds due to me will be processed per the refund policy of Delgado Community College. I understand that VA funds may be disbursed later than other financial aid, and I am asked to be patient with the processing of payments.*

I understand that when I submit this form along with my certificate of eligibility, Delgado Community College will place a temporary credit on my account to keep my classes from being dropped. (I understand that credit can change based upon actual payments).*

I understand that the Post 9/11 GI Bill will not cover the following fees: application fee, testing fees, and late registration fees.*

I agree that the courses I am registered for this semester count toward my current major at Delgado (as listed in LoLA). I understand that if any of the courses that I am taking do not apply to my degree, they will not be certified and that I will be responsible for the cost. I also agree to allow the reporting of my enrollment status to the Department of Veterans Affairs for the purpose of receiving education benefits.*

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Request for Certification Form (West Bank and Jefferson)