New Student Intake Form
Interactive intake form with automatic data persistence
Your progress is automatically saved
Use your browser's print function (Ctrl+P / Cmd+P) to save as PDF
VA Education Benefits Student Intake Form
Please complete this form in full and submit along with your Certificate of Eligibility (COE)
Student Information
VA Benefit Information
⚠️ Important: Your enrollment cannot be certified to the VA without a valid Certificate of Eligibility. If you don't have your COE yet, you can request it at www.va.gov/education or call 1-888-GI-BILL-1.
This is shown on your COE
Date by which benefits must be used
Academic Information
e.g., Associate's, Bachelor's, Master's, Certificate
Enrollment Information for Upcoming Term
Student Responsibilities & Acknowledgments
Please type your initials in each box to indicate you understand your responsibilities:
Initial
I understand I must notify the School Certifying Official within 30 days of any changes to my enrollment (drops, adds, withdrawals, or grade changes).
Initial
I understand that if I stop attending a course, I must officially withdraw and report my last date of attendance to avoid overpayment debt.
Initial
I understand that only courses required for my degree program are eligible for VA benefits.
Initial
I understand I am responsible for any overpayments resulting from failure to report enrollment changes or from providing inaccurate information.
Initial
I understand I must maintain satisfactory academic progress according to my institution's standards to continue receiving VA benefits.
Initial
I authorize the School Certifying Official to release my enrollment and academic information to the VA for the purpose of benefit certification.
Student Certification
I certify that the information provided on this form is complete and accurate to the best of my knowledge. I understand that providing false information may result in termination of benefits and/or criminal penalties.
For Office Use Only
💡 How to Use This Interactive Form
Your progress is automatically saved to your browser. You can fill out the form over multiple sessions.
Watch the progress bar at the top to see how much of the form you've completed.
Click the print button to create a PDF with all your information included.
All data stays in your browser - nothing is sent to any server until you submit the completed form.
Related Resources
Automate Student Onboarding
VASCO Pro Software includes digital intake forms, automatic COE verification, document management, and student portal access. Onboard new VA students in minutes, not days.