U.S. Flag emblem    Veterans 
Enrollment Verification Form

Your signature below indicates the following:
1. Information is correct.
2. Permission to release information for financial aid determination.
3. You are responsible for paying fees and tuition costs within UW-L deadlines.
4. You are responsible for informing the Veterans Benefits Coordinator of any changes in enrollment each semester.  E-mail Ms. Lehrke

links to UW-La Crosse Home Page
Records & Registration

How to use this form:
1. FILL OUT FORM
2. P R I N T
3. S I G N
4. M A I L to:

Sharyn Lehrke
Veterans Benefits Coordinator
117 Graff Main Hall
La Crosse, WI 54601
  608-785-8751

Last Name:  First Name:  Initial: 

Chapter 35 ID#  (If Available)  DOB  Undergraduate Graduate
Social Security number:  Graduation Date:   New Address? 

Address for payment or verification form
City:  State: Zip Code:  

Select One:  Email: 
Certification for 2007-2008:   Status: 
 

County Veterans Services Office (608) 785-9719
1-888-442-4551 or 1-888-GI-BILL1 or  http://www.gibill.va.gov

How many credits are you registering for this semester?
 credits - Fall
credits - Spring
Did you use your MGIB at UW-L last semester? 

Are you repeating or auditing any classes ? 
Course/Grade:

Are you registered for classes below 100 level ? 
Course/Credits

If you are a new applicant for the MGIB, ask for VA form 22-1990.

MGIB at another  institution? - when & where?  Please check (b) box below
Major there

I request a change of program or place of training (b)

Have you changed your Major ? 
If YES, enter new major, date and (b) box above

 Signature                                                                                                                                                                    Date

Enrollment verification required each semester following registration