FSU Veteran Request for Benefits

Indentifying Information

Requests are processed in the order in which they are received.

Please try to avoid emails asking for a status update as this only delays processing. Be sure to check your FSU email clutter or junk file for a notification your claim was received. You should receive one from FSU SVC after submtting this form and one from the VA once completely processed by our office and submitted to the VA.

Your request for benefits form must be received by the 5th day of class each semester in order to avoid being assessed a late fee. A deferment will automatically be placed on your account prior to payment deadline and a separate request is not required.

****Please DO NOT complete this form until AFTER your schedule is set, your certification WILL NOT BE processed. ****

What Campus are you requesting VA educational benefits for? *

Main Campus

Republic of Panama Campus

Panama City Florida Campus

FSU Term to be certified. Please complete one form for each semester. *

Fall

Spring

Summer

Other - Other -

Please provide your destination city if studying abroad and dates of enrollment.

Contact the Student Veterans School Certifying Officer for details regarding payment of study abroad charges.

Please indicate how many credit hours you are enrolled in each summer term (e.g. A - 6, B - 3, etc.).

Summer A (1st 6 weeks)

Summer B (2nd 6 weeks)

Summer C (12 or 13 weeks)

Summer F (8 weeks)

Year of semester to be certified *

First Name *

Middle

Last Name *

FSU Email Address *

Date of Birth (mm-dd-yyyy) *

Primary Phone *

Are you a Florida Resident?

IMPORTANT NOTICE: Please check your account before answering. Newly admitted and readmitted pursuing a second degree must submit a Online Residency Declaration Form with the Admission Application to receive in-state tuition. If you are out-of-state living in Florida, additional documentation will be required to obtain an OOS waiver from the Student Veterans Center. *

Yes

No

Mailing Address *

City *

State *

Zip Code *

What VA education benefits are you applying for? Please be careful in your selection.
*

Chapter 30 (Veteran Montgomery GI Bill®)

Chapter 31 (VR&E, Veteran Readiness & Employment)

Chapter 33 (Post 9/11 Veteran)

Chapter 33 Transfer of Entitlement (Post 9/11 Dependent)

Chapter 35 (Dependent of Disabled or Deceased Veteran)

Chapter 1606 (Selected Guard/Reserve)

Fry Scholarship (Child/spouse of an active-duty service member who died in the line of duty on or after 9/11/2001)

Please provide your VR&E Counselor's email address below *

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ATTENTION Post 9/11 or Fry Scholarship - A deferment will be automatically placed on your account the week payment is due. You will continue to receive notices from Student Business Services but payment will not be due until the end of the semester allowing time for VA to pay your tuition.

If you submit your Request For Benefits form by the 5th day of class each semester, this process will be automatic. Please take advantage of Priority Registration and submit any necessary forms well in advance of the 5th day of class if your schedule is complete.

Should you submit your Request for Benefits AFTER the 5th day of class, you could possibly incur a late fee.

These deadlines are published in the university Registration Guide each semester.

Veteran's SSN and First and Last Name (Chapter 35 ONLY) *

ATTENTION CHAPTER 31 VR&E, VETERAN READINESS & EMPLOYMENT STUDENTS

You will need a different authorization other than the one used for tuition if you plan to use the FSU Bookstore. You will need to make arrangements for this with your counselor not the Student Veterans Center. It should contain the following billing information:

MAIN CAMPUS

Billing Address should read:

Florida State Univ Bookstore #208

Parking Garage/Main Level

Tallahassee, FL 32308

PANAMA CITY CAMPUS

Billing Address should read:

PANAMA CITY CAMPUS:

Follett Higher Education Group
Florida State University Bookstore-Panama City
4750 Collegiate Drive
Holley Building

Panama City, Florida 32405

What percentage level of Post 9/11 Chapter 33 are you eligible for:

The following information is about the student, not the military family member.

Are you currently on "active duty"? *

Yes

No

Are you the spouse of an active duty member? *

Yes

No

Were you discharged or did you retire from the U.S. military? *

Discharged

Retired

Medically Retired

Actively drilling Guard/Reservist

What branch of military service were or are you a participant in? *

Did you serve prior to 9/11/01? *

Yes

No

Did you serve on or after 9/11/01? *

Yes

No

Are you a member of the:

Those using FTA or EDD must also provide an Agency Billing form to Student Business Services to obtain proper military deferment. Student Veterans Center must also have copies of proper documentation if you are using VA educational benefits and any of the following.

Do you plan to use any of the following? (check all that apply)
* 🛈

ROTC Tuition Scholarship

Military FTA (must provide authorization documentation)

EDD (please provide copy of FLNG 704 EDD App documenting request was made and pending authorization.)

Not Applicable

If you are using EDD or Federal Tuition Assistance (TA) to pay your tuition, you MUST complete an additional form handled through Student Business Services.

You can access the Agency Billing form here https://studentbusiness.fsu.edu/forms

Please submit the Agency Billing form to Student Business Services before the fifth day of classes to avoid a late payment fee.

Academic Information

Degree: *

What is your primary major? *

What is your minor? (must be required by degree program)

Are you pursuing a dual major? *

Yes

No

Are you pursuing a dual degree? *

Yes

No

If so, what is your secondary major/degree? *

Do you have a graduate assistantship that you will be receiving a departmental waiver for tuition? *

Yes

No

What is your expected graduation semester and year? *

I am a: *

Description Text

***All non-degree seeking or provisional students using VA educational benefits must provide a letter from someone of authority in your department at Florida State University stating the following before certification for benefits can be processed:

* What educational goal you are attempting

* Reason you are not degree seeking

* Specific coursework (name and number) you will be taking

There is an area below to upload a scanned copy of this letter.

**Transient or Dual-Enrolled students must provide primary institution name below. A copy of your Parent School Letter is required (may be scanned and attached to the end of this document). *

Schedule Information

Number of credit hours to be certified this semester? *

Please list courses to be certified. Ex: ENC1101, MAC1105, etc.. *

.

Are you repeating any courses? *

Yes

No

What course(s) are you repeating? *

Do you have or intend to purchase FSU health insurance *

Yes

No

THIS IS IMPORTANT INFORMATION REGARDING YOUR VA EDUCATION BENEFITS

Changes in course enrollment after the last day to drop and add courses may result in the retroactive loss of benefits unless the VA finds mitigating circumstances involved in the change. Loss of benefits could revert back to the first day of the term.

You will only be paid for those courses that meet degree requirements in the educational program on file with the FSU Student Veterans Office.

Chapters 33, 30, and 1606 must verify continued enrollment at the end of each month of the semester by web or toll-free number to receive payment of educational benefits.

CH 30 and 1606 Visit http://www.benefits.va.gov/gibill/ or call 1-877-823-2378.

CH 33: Verify your enrollment via text message or by calling the Education Call Center (ECC) 1-888-GIBILL-1 (1-888-442-4551). The ECC can also help you opt into text verification. VA strongly recommends verifying enrollment via text.

Please CHECK after reading each item: *

EACH TERM I must report my registration in my enrollment to the FSU Student Veterans Center by submitting the Request for Benefits in order to receive my benefits.

I will report any changes to my enrollment to the Student Veterans Center after a Request for Benefits has been submitted by submitting an email using to my FSU email.

I must be enrolled in an approved program of study that leads to a standard degree or certificate and have all prior (official) transcripts on file at FSU by the end of my third term of enrollment.

I understand that I will not be paid by the VA for classes previously passed at FSU or other institutions.

I will ensure that the classes I am taking are required by my program.

I understand that I must make satisfactory progress toward graduation.

I understand that counselor advisement/error is not an acceptable reason for taking classes not applicable to my program.

Ch. 33-Post 9/11 GI Bill and Fry Scholarship Information and Responsibilities

Housing Allowance

The Chapter 33 housing allowance is NOT payable if you are currently active duty or spouse of an active duty member.

If you are solely distance learning your BAH will be based on ½ the national average BAH.

The housing allowance is prorated by rate of pursuit (rounded to nearest tenth)

A ¾ time student would receive approximately 80% of the BAH rate

The housing allowance for classes taken on Main Campus is paid based on the Tallahassee zip code (32306).

Effective Fall 2018 and beyond, courses taken at another teaching site (EXCLUDING internships, practicums, clinicals, student teaching ) will be reported based on the zip code where the course physically takes place. The VA will pay housing based on where the majority of the courses are physcially taken. For more information, please contact the Student Veterans Center.

Tuition & Fees

Chapter 33 will pay a percentage of your tuition and normal fees for courses that meet degree requirements in your educational program on file with the FSU Student Veterans Center. The percentage is based on the time you spent on active duty after September 10, 2001. The percentage will vary from 40% to 100%.

Those using the Fry Scholarship, your tuition should be covered at the 100% level for courses that meet degree requirements in your educational program on file with the FSU Student Veterans Center.

If you withdraw from or stop attending classes, you will be required to pay back the tuition and fees for those classes to the university. DO NOT withdraw from any class or classes without talking to someone at the FSU Student Veterans Center regarding the amount you will have to pay back. Any tuition paid to the school by the VA will be refunded to the VA and therefore you will incur a debt to the school. If you have Federal Financial Aid you may also have obligations as well. For more information regarding Federal Financial Aid please contact the Office of Financial Aid.

You should be aware that the ultimate responsibility for the payment of tuition and fees is YOUR responsibility. You will not be allowed to register for or attend any further terms until all your financial obligations to the university for the current term are met.

Please check the box below once you have read the tuition and fee information provided above. *

I have read and undertand these conditions

Book Stipend

The book stipend will be paid to the student at the beginning of each term and will be based on your benefit percentage and the number of credit hours you are taking. Maximum payment is 24 credit hours in an academic year (fall through summer).

Conditions

In the event that the student is not eligible for the maximum eligibility, payment must be received by FSU immediately unless a deferment is in place. It is the student’s responsibility to make payment within the appropriate dates without regard for the University’s billing procedures or postal delays.

If enrollment is terminated for any reason, the unpaid balance of tuition and fees is due and payable immediately. A student who fails to make full payment of tuition and fees, including any incidental fees, by the due date may be prohibited from registering for classes until full payment is made.

Authorization

Upload one PDF document (can be multiple pages but ONE PDF).
This can be the Certificate of Eligibility, Award Letter, etc. Any document you wish the SVC to have can be uploaded.

This area is reserved for any additional information (e.g. Confirmation number of VA form submitted) that you might need to tell us.

I give my permission for the school certifying official to review my educational record.

I acknowledge and understand that this form has been created through, and is administered by, FormSite, a third-party administrator. The form is secure, all data within it is encrypted, and the data is accessed only by appropriate university officials. By completing this online form, I am consenting to the sharing of the information contained herein with FormSite, as deemed necessary by Florida State University and FormSite, for purposes related to the processing of my request.

*Note to User: You can read more about FormSite’s privacy and security at http://www.formsite.com/documentation/security.html, and http://www.formsite.com/privacy.html.

If you DO NOT consent to the use of FormSite for processing of this form, please visit the Student Veterans Center to fill out a hard copy form.

By signing below, I affirm that I have read, understand, and will abide by the information above.

Please enter your FSU login for confirmation. DO NOT give us your password please! *

Date (MM-DD-YYYY) * +

Bachelor of Science	Bachelor of Arts	Master of Science
Master of Arts	PhD	Other Other

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