College of Southern Maryland - Veterans Education Benefits Request Form


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Veterans Education Benefit Request

To apply for VA educational benefits at CSM, complete this form:

Registrar’s Office
College of Southern Maryland
8730 Mitchell Road
P.O. Box 910
La Plata, MD 20646-0910

Contact Information
Natalie Transue - ntransue@csmd.edu
Registrar’s Office - 301-934-7588
Fax: 301-934-7698

If you are a new applicant at CSM or there has been a change in your status from your last registration at CSM, our office will provide you the necessary VA forms for claiming your educational benefits. This form is also available on the VA’s web site under Education Benefits and Education Forms.
Veterans may not receive VA benefits for pursuit of the same courses for which employee tuition assistance is received from the federal government.
If you would like VA assistance, call the VA’s toll free number 1-888-GIBILL1 (442-4551).

You MUST contact our office if you withdraw from, add or change your class schedule in any way. You can simply send an email to ntransue@csmd.edu with your schedule changes.
The Registrar’s Office is open Monday through Friday from 8:30 a.m. to 4:30 p.m.
For more detailed information regarding your claim for VA Educational Benefits, consult the Guide to Veterans’ Educational Benefits, available in the Registrar’s Office and on our web site, http://www.csmd.edu/current/Veterans/.

Please fill out the form below, then click the "Send the Form" button to submit.

* Denotes a Required Field

Student ID: * (7-digit with preceeding zero ex: 0123456)
* If you do not know your CSM Student ID number, you may obtain it via Online Services.

First Name: *
Middle Name: *
Last Name: *

Street Address: *
City: *
County: *
State: *
Zip Code: *

One Phone Number is Required * Home Phone Number:
Format: XXX-XXX-XXXX
Work Phone Number:
Format: XXX-XXX-XXXX
Mobile Phone Number:
Format: XXX-XXX-XXXX

E-mail: Required if you would like a confirmation message sent to you

Date of Birth:

Dates Served on Active Duty: *
Note: If you are a dependent of a deceased or disabled veteran, you must enter the veteran's service dates.
to

Indicate the semester for which VA Benefits are requested: *
Fall Spring Summer

Which campus will you attend?
La Plata Leonardtown Prince Frederick Waldorf Center

Curriculum/Program of Study: *

Your Veteran Status: *
Veteran (not currently on active duty)
Active Duty
Dependent of a deceased or disabled veteran (where the death or disability is service-connected)
Reservist/National Guard
Vocational Rehabilitation
GI Bill Type (if known): Chapter

Education Status

Have you ever received VA Education Benefits before? *
No
Yes
School City, State

Are you also enrolled this semester at any other college? *
No
Yes
School City, State

Which school will be certifying you to VA? *
CSM
School Named Above

Student Schedule

You must be registered for classes prior to filling this form out. List all classes for the current semester. List all laboratories separately. Audited or repeated courses should be indicated by “Audit” or “Repeat”. Place a check in the block labeled “DO NOT CERTIFY” if you do not wish to receive benefits for that class. Note: VA does not pay for audited courses or courses that do not count toward your degree at the College of Southern Maryland. All persons withdrawing from, adding, or changing classes are responsible for notifying the Registrar’s Office.

Do Not Certify	Course Dept.	Course No.	Section	Credit Hours	Audit or Repeat

EXAMPLE:	ENG - English	1010	12345	3

By submitting this application, I guarantee payment of all financial obligations to the College of Southern Maryland, and I accept and agree to abide by all of the policies and regulations of the College of Southern Maryland. In addition, I further understand that the unlawful use of drugs or alcohol will subject me to the penalties contained in those policies and regulations. I also certify the information which I have given on this veterans education benefits request form, is accurate and complete. (Failure to provide accurate information, particularly regarding residency, may be just cause for disciplinary action as well as require reimbursement to the college for any underpayment of tuition). I understand that it is my responsibility to notify the Registrar’s Office of any changes in the information contained in this application.

I have read and agree with the above statement.

Veterans Applying for Advance Payment

Veterans expecting advance payment must realize that CSM cannot assume responsibility for checks not received in time to pay for classes. CSM DOES NOT DEFER PAYMENT OF TUITION AND FEES. Students must put 20% down at the time of registration and must be prepared to pay for the rest of their tuition and fees by the 100% due date.

To apply for advance payment for this semester, read the following statements and sign and date on the indicated lines below. An advance payment check will pay for the first and second month.

The VA must receive your enrollment certification from CSM, along with your application for advance payment, for the upcoming semester AT LEAST 30 DAYS (BUT NO MORE THAN 120 DAYS) before the beginning of the semester. You must currently be registered (at least half-time) for classes in order to receive advance payment.

STATEMENT:

I am aware that advance payment checks are mailed directly to the La Plata campus, and that I must, personally, come to the La Plata campus to sign for and pick up my check. Following my advance payment check, future payments will come directly to me from the VA either by direct deposit or by mail.

I hereby request advance payment for the