Class Climate online-survey - semester worksheet 1

1Spread Sheet information

1.1 TERM? (example Fall-2017 or Spring-2019 or Summer 2015) Mandatory field

1.2 Student ID # Mandatory field

1.3 Last Name: Mandatory field

1.4 First Name: Mandatory field

1.5 Last 4 numbers of your VA file number? Mandatory field

1.6 Email Address (very important for benefits information): Mandatory field

(maximum 45 characters)

Remaining characters for the answer of this question 45

1.7 Phone number format (000-000-0000): Mandatory field

- -

1.8 Are you Mandatory field

1.9 What benefit chapter are you using? Mandatory field

1.10 What % do you qualify for your benefit? (Enter 0 if you do not know) Mandatory field

1.11 Remaining months of benefit? (Enter 0 if you do not know) Mandatory field

1.12 Major? Mandatory field

1.13 Are you? Mandatory field

If this is your first term transferring to Minot State you are required to complete additional paperwork (DD 22-1995) to be certified, please contact the Veteran Center office.

1.14 Number of credits enrolled in this semester at Minot State? Mandatory field

Changes made to your schedule after submitting this form need to be reported to the Minot State Veteran Center office. Your changes may create a debt for you that will require re-payment of VA educational benefits you may have already received (book stipend, housing, tuition and fees).

1.15 Are you repeating any courses (enter 0 if no, list repeated courses if yes)? Mandatory field

(maximum 150 characters)

Remaining characters for the answer of this question 150

1.16 Are you taking Collaborative classes (enter 0 if no, list course and school if yes)? Mandatory field

(maximum 150 characters)

Remaining characters for the answer of this question 150

1.17 Are you using tuition waivers (enter 0 if no, list waivers below if yes) Mandatory field

(maximum 50 characters)

Remaining characters for the answer of this question 50

1.18 Are you receiving scholarship(s) (enter 0 if no, list scholarship(s) if yes) Mandatory field

(maximum 150 characters)

Remaining characters for the answer of this question 150

1.19 Your instructor will be contacted if you receive a failing grade. It is important to understand that the VA pays you for attending class, not just registering for the course(s) Mandatory field

1.20 The VA WILL NOT pay for repeated courses (unless the course you are repeating requires a higher grade than you received initially) Mandatory field

1.21 The VA WILL NOT PAY FOR AUDITED COURSES Mandatory field

1.22 Chapter 30, 1606 and 1607 recipients must verify their enrollment monthly (online via W.A.V.E. or by phone) Mandatory field

1.23 FAILURE TO NOTIFY THE MINOT STATE VETERANS OFFICE OF CHANGES TO MY SCHEDULE MAY RESULT IN AN OVERPAYMENT OF BENEFITS WHICH I WILL BE RESPONSIBLE TO PAY BACK TO THE VA Mandatory field

1.24 I consent to the release to the US Department of Veterans Affairs all of my educational records maintained by Minot State University, including my Social Security Number to allow me to receive VA educational benefits Mandatory field