Employee Wellness Workout Tracker Fields marked with an * are required General Info General Information First Name * Last Name * Connors ID Number * Mailing Address * City * State * - Select State - Alabama Alaska Arizona Arkansas California Colorado Connecticut Delaware Florida Georgia Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Hampshire New Jersey New Mexico New York North Carolina North Dakota Ohio Oklahoma Oregon Pennsylvania Rhode Island South Carolina South Dakota Tennessee Texas Utah Vermont Virginia Washington West Virginia Wisconsin Wyoming Washington DC ARMED FORCES AFRICA \ CANADA \ EUROPE \ MIDDLE EAST ARMED FORCES AMERICA (EXCEPT CANADA) ARMED FORCES PACIFIC Zip * Phone * CSC Email * Semester Info Semester Semester * Select One Fall Spring Summer Year * Student Status Student Status What is your current standing? * New Student Continuing Transfer Concurrent Enrollment Re-admitted Education Status Education Status Which VA program are you using? * Select One Chapter 30 (MGIB) Chapter 31 Vocational Rehab Chapter 33 Post - 9/11 GI Bill® Chapter 35 DEA Chapter 1606 (MGIB-SR) Will you be receiving the OK Tuition Waiver (National Guard)? * Yes No Are you taking courses at another institution? Yes No If so, which one? Have you spoken with the School Certifying Officer? Yes No Have you declared your major? Yes No If so, what is your major? Have you met with your academic advisor and are you following the degree audit outlined for your major? Yes No Class Schedule Class Schedule Please list courses that you want to be certified with Veterans Affairs. Classes not listed but enrolled in will not be counted in certification. Statement of Understanding Statement of Understanding As a CSC student using VA benefits, it is my responsibility to report classes to the Veterans Services Office in a timely manner. As a CSC student using VA benefits, it is my responsibility to report any and all changes with enrollment, status, degree plan, benefits, and/or conflicts to the Veterans Services Office via email: cherokee.riddle@connorsstate.edu As a CSC student using VA benefits, I certify that the all information given on the Information Sheet is correct to the best of my knowledge. If information changes during a semester, I will email the Veterans Services office at: cherokee.riddle@connorsstate.edu I understand the conditions and wish to submit my information sheet. * GI Bill® Information Statement 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 Web site at http://www.benefits.va.gov/gibill If you are a human seeing this field, please leave it empty.