Certification Of Military/veteran/dependent Status printable pdf download

Certification of Military/Veteran/Dependent Status

Name_____________________________________ SFCC ID#________________

To verify eligibility, individuals must provide SFCC the appropriate military/VA documentation which reflects your GI Bill eligibility status and sign the

applicable below statement. Complete and sign this form in front of an SFCC employee or a notary.

SELECT YOUR STATUS

___ Active Duty Military (go to #1)

___ Active Duty Military Dependent (spouse or child) (go to #1)

___ Current Guard/Reserve Member (go to #2) ___ Current Guard/Reserve Dependent (spouse or child) (go to #2)

___ Veteran (retired/separated) (go to #3)

___ Veteran Dependent (spouse or child) (go to #3)

Active Duty Member/Dependent –Show your military ID card to the SFCC employee/notary.

I hereby verify that I am active duty military or an active duty military dependent with a military identification card.

Member/Dependent Signature: ____________________________________________________________

2. Guard/Reserve Member/Dependent – Show your military ID card, or a copy of your VA Education Benefits

Certificate of Eligibility letter, or provide a copy of member’s DD Form 214 to the SFCC employee/notary.

I hereby verify that I am currently in the Guard/Reserve or I am a Guard/Reserve member’s dependent with a military

identification card or I have a VA Education Benefits Certificate of Eligibility letter.

Member/Dependent Signature: ____________________________________________________________

If using a DD Form 214 as your documentation for a dependent student, complete the following statement and sign below.

I hereby verify that ___________________________________________________________ is my dependent.

Guard/Reserve Member Print/Sign: _________________________________________________________

Dependent Print/Sign: __________________________________________________________________

3. Veteran/Veteran Dependent – Show your military ID card, or a copy of your VA Education Benefits

Certificate of Eligibility letter, or provide a copy of member’s DD Form 214 to the SFCC employee/notary.

I hereby verify that I am a military veteran or I am a military veteran’s dependent with a military identification card or I

have a VA Education Benefits Certificate of Eligibility letter.

Member/Dependent Signature: ____________________________________________________________

If using a DD Form 214 as your documentation for a dependent student, complete the following statement and sign below.

I hereby verify that __________________________________________________________ is my dependent.

Guard/Reserve Member Print/Sign: _________________________________________________________

Dependent Print/Sign: __________________________________________________________________

SFCC/Notary Certification

I have confirmed the military member/veteran/dependent listed above is eligible for the in-district tuition rate (i.e. eligible

for GI Bill) based on the documentation provided and the signed statement.

SFCC Employee/Notary Signature: __________________________________________ Date: ______________

Certification Of Military/veteran/dependent Status

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