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VA Registration Form

Last Name:     First Name:
Email Address:       Last 4 SSN:
Street:     City:     State:     Zip:
JSU Student #:    Phone:

Term:     Major:
Are any of these classes repeats?    No     Yes
Any course in which a D or higher has been earned cannot be repeated and receive V.A. payment for it.

List Courses for Which You Are Registering
Ex: EH 101 English Composition 3
Dept Course Course Title Hrs

      I authorize the Veterans Affairs office at Jacksonville State University to receive a copy of my transcript from the Admissions Office.

I further authorize the Veterans Affairs Office to receive a copy of my grades each term that I am enrolled and receiving veterans benefits.

I understand that the above information will be used only as needed to keep in receipt of veterans benefits.

I further understand that by failing to complete a class registration card will indicate to the VA Office that I am not registered and my VA benefits will be terminated.

I will notify the VA office of any change to this schedule to allow them to correct my VA file.

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