UDC Student ID # (required)

First Name (required)

Middle Initial

Last Name (required)

Address (required)

City (required)

State (required)

Zip Code (required)

Phone

Email

How many clock hours (or) credit hours are you/will you enroll

What is your declared program of study?

By checking the boxes below, I acknowledge, understand and agree to adhere to the following:

I am the person stated on the top of this form and I authorize UDC Veterans Affairs Office to certify me for the stated clock hours I indicated on this form.I am responsible for knowing the rules and regulations of the VRAP Program. Updates are always found at www.gibill.va.gov.I have read this complete form and agree to the policy and procedures on receiving my VA Educational Benefits through UDC Veterans Affairs Office.I accept full responsibility to pay all tuition and fees charged to me for the program I have selected to enroll in.I understand, the VA does not pay the school for tuition and fees owed for any reason.I am responsible for purchasing all books and supplies as well as transportation to and from school.

Please make sure you check all boxes.

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