VA REGISTRATION PACKET Thank you for your interest in UC Davis Continuing and Professional Education certificate programs. This registration packet includes the following forms and documents: 1. VA Education Benefits Checklist 2. UC Davis Continuing and Professional Education VA Benefits Intake Form 3. UC Davis Continuing and Professional Education Terms & Conditions Eligible students may utilize their VA educational benefits for approved certificate programs only. Please visit the GI Bill website and use the WEAMS tool to verify program eligibility, benefits.va.gov/gibill/school_locator.asp. Veterans, veteran dependents and others eligible for veterans education programs should determine their benefits and obtain authorization with the Department of VA prior to enrolling in courses. Please visit the GI Bill website for more information on how to apply and determine eligibility for benefits, benefits.va.gov/gibill. VA REPRESENTATIVE UC Davis Continuing and Professional Education accepts these benefits: Chapter 30 - Montgomery GI Bill Active Duty (MGIB-AD) Chapter 31 - Vocational Rehabilitation and Employment Program (VR&E) Chapter 33 - Post 9/11 GI Bill Chapter 35 - Dependents Educational Assistance (DEA) Chapter 1606 - Montgomery GI Bill Selected Reserves (MGIB-SR) Chapter 1607 - Reserve Educational Assistance Program (REAP) Once you have completed the forms, please submit them using one of the following methods: Mail to: UC Davis Continuing and Professional Education Attn: Diane Bynum Carr 2901 K St., Ste. 204 Sacramento, CA 95816 Diane Bynum Carr Phone: (916) 327-0007 Fax: (916) 327-0008 Email: cpe-va@ucdavis.edu Mailing address: 2901 K St., Ste. 204 Sacramento, CA 95816 QUESTIONS? If you have any additional questions, please contact us: Email: cpe-va@ucdavis.edu Call: (916) 327-0007 Fax to: (916) 327-0008 Attn: Diane Bynum Carr GI Bill is a registered trademark of the U.S. Department of Veterans Affairs (VA). More information about education benefits offered by VA is available at the official U.S. government website at benefits.va.gov/gibill. 1333 Research Park Drive, Davis, CA 95618 (800) 752-0881 cpeinfo@ucdavis.edu cpe.ucdavis.edu
VA EDUCATION BENEFITS CHECKLIST In order to use your VA benefits, the school will need documentation to begin your VA file. Listed below are the benefits we accept and the documents required. VETERANS Chapter 30 - Montgomery GI Bill Active Duty (MGIB-AD) A copy of your VA Form 22-1990 or VA Form 22-1995 if you previously used VA Education Benefits A copy of your DD214 Member 4 Copy Chapter 31 Vocational Rehabilitation and Employment Program (VR&E) VA Form 1905 Authorization Form from your VA VR&E Counselor Chapter 33 - Post 9/11 GI Bill A copy of your DD214 Member 4 Copy A copy of your VA Form 22-1990 or VA Form 22-1995 if you previously used VA Education Benefits Chapter 1606 Montgomery GI Bill Selected Reserves (MGIB-SR) A copy of your NOBE Notice of Benefit Eligibility Chapter 1607 Reserve Educational Assistance Program (REAP)
DEPENDENTS OF VETERANS Chapter 33 - Post 9/11 GI Bill, Transferred Benefits A copy of your VA Form 22-1990e or VA Form 22-5495 if you previously used VA Education Benefits Chapter 35 Dependents Educational Assistance (DEA) A copy of your VA Form 22-5490 or VA Form 22-5495 if you previously used VA Education Benefits
VA EDUCATION BENEFITS INTAKE FORM PLEASE TYPE OR PRINT CLEARLY Thank you for your interest in VA Education Benefits at UC Davis Continuing and Professional Education. Please take a few minutes to fill out the following information. TODAY S DATE BIRTHDATE SOCIAL SECURITY NUMBER I AM A VETERAN SPOUSE/DEPENDENT OF A VETERAN VA FILE NUMBER (if different from SSN) LAST NAME FIRST NAME INITIAL STREET ADDRESS CITY STATE ZIP PHONE NUMBER WORK NUMBER EMAIL ADDRESS Will you be enrolling into a UC Davis Continuing and Professional Education certificate program? YES NO NAME OF PROGRAM If NO to the previous question, state the name of your home campus: UNDER WHAT CHAPTER WILL YOU BE DRAWING BENEFITS? (CHECK ONE) CHAPTER 30 (MONTGOMERY GI) CHAPTER 31(VR&E) CHAPTER 33 (POST 9/11) CHAPTER 35 (DEPENDENTS) CHAPTER 1606 (RESERVES) CHAPTER 1607 (REAP) Have you previously used your VA Education Benefits? YES NO If YES what was the last school you attended? Are you on active duty? YES NO Are you in the Selected Reserves? YES NO UC Davis Continuing and Professional Education is required to evaluate previously completed coursework for students using VA Education Benefits. Students must submit transcripts of post-secondary education to the UC Davis Continuing and Professional Education VA Representative no later than 30 days after enrolling in courses. UC Davis Continuing and Professional Education evaluates all supporting documents to determine if any credit may be applied to the student s approved program of study. Students granted credit will have their training program and tuition reduced proportionately. List all previous post-secondary educational institutions attended: Highest level of education obtained: I certify that the information I have provided on this form is true and accurate to the best of my knowledge. I understand that omission of any information, or reporting untrue information, may result in the termination of my benefits at UC Davis Continuing and Professional Education. STUDENT SIGNATURE DATE FOR OFFICE USE ONLY Signature of Evaluator Date Prior transcript has been evaluated: YES NO Notes: (for evaluator s use only)
UC DAVIS CONTINUING AND PROFESSIONAL EDUCATION TERMS & CONDITIONS Please read and sign that you understand the policies and procedures below. VA STUDENT RESPONSIBILITIES I understand that it is my sole responsibility to notify the UC Davis Continuing and Professional Education VA Representative in writing of any changes to my student records within 3 business days. I understand that I must report course drops, course failures, course cancellations, course date changes, grade option changes and/or withdrawal from a program. I understand that in order to make changes to my program/area of study, I must submit a written request to the VA Representative. I agree to provide UC Davis Continuing and Professional Education with supporting documentation necessary to determine if any credit may be granted for my approved program. I understand that failure to submit my transcript(s) may result in a delay of certification or future course enrollment at UC Davis Continuing and Professional Education, until my transcript(s) are received. I understand that UC Davis Continuing and Professional Education will hold me responsible for any tuition fees not paid by the VA, or payments rescinded by the VA. Receiving grades of Not For Credit (NFC), No Record (NR), Fail (F), or Not Passing (NP), may result in a reduction in benefits for all VA funded students. Failure to notify my VA Representative of any actions that may affect my status or program requirements may result in termination of my benefits and/or retroactive billing of my benefits. ACADEMIC PERFORMANCE - IMPORTANT Students funded by the VA are required to meet minimum satisfactory progress. I understand that if my GPA falls below 2.0 for one (1) quarter, I will be put on academic probation. If my GPA falls below 2.0 for two (2) consecutive quarters, my benefits will be terminated. To reinstate my benefits, I must meet with the VA Representative to establish an education plan. I will also be required to pay for courses out-of-pocket for one quarter and maintain a minimum GPA of 2.0 before benefits will be re-certified. VERIFICATION OF ENROLLMENT UC Davis Continuing and Professional Education students using benefits under the Montgomery GI Bill Active Duty and Selected Reserve must verify attendance each month for non-college degree programs. Students should verify their attendance on the last calendar day of the month to receive monthly payments from the VA. Please note: Students using Post 9/11 GI Bill benefits are not required to verify attendance. Your enrollment can be verified by using the Web Automated Verification of Enrollment (WAVE) at gibill.va.gov/wave or by calling the toll free Interactive Voice Response (IVR) telephone line at (877) 823-2378. Students receiving Chapter 35 Dependents Educational Assistance (DEA) benefits who are enrolled in a non-college degree program can only verify attendance by calling 1-888-GI BILL-1 (1-888-442-4551). I have read, understand and agree to the UC Davis Continuing and Professional Terms & Conditions. First and Last Name (Print) Signature and Date