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# MILITARY STUDENT SERVICES ENROLLMENT REPORTING FORM

## Note: This form must be completed each term

Name:

Student1.D.Number:___

DegreeProgram:___

Military Benefit: ☐ 30 ☐ 31 ☐ 32 ☐ 33 ☐ 35 ☐ 1606 ☐ 1607 ☐ MYCAA ☐ STA ☐ FTA ☐ ROTC ☐ DWV

Term: Fall _____ Spring: _____

Winter _____ Summer _____


<table border=1 style='margin: auto; word-wrap: break-word;'><tr><td style='text-align: center; word-wrap: break-word;'>DEPARTMENT</td><td style='text-align: center; word-wrap: break-word;'>COURSE NUMBER</td><td style='text-align: center; word-wrap: break-word;'>SECTION</td><td style='text-align: center; word-wrap: break-word;'>HOURS</td><td style='text-align: center; word-wrap: break-word;'>CURRICULUM SHEET</td><td style='text-align: center; word-wrap: break-word;'>COURSE SUBSTITUTE</td></tr><tr><td style='text-align: center; word-wrap: break-word;'></td><td style='text-align: center; word-wrap: break-word;'></td><td style='text-align: center; word-wrap: break-word;'></td><td style='text-align: center; word-wrap: break-word;'></td><td style='text-align: center; word-wrap: break-word;'></td><td style='text-align: center; word-wrap: break-word;'></td></tr><tr><td style='text-align: center; word-wrap: break-word;'></td><td style='text-align: center; word-wrap: break-word;'></td><td style='text-align: center; word-wrap: break-word;'></td><td style='text-align: center; word-wrap: break-word;'></td><td style='text-align: center; word-wrap: break-word;'></td><td style='text-align: center; word-wrap: break-word;'></td></tr><tr><td style='text-align: center; word-wrap: break-word;'></td><td style='text-align: center; word-wrap: break-word;'></td><td style='text-align: center; word-wrap: break-word;'></td><td style='text-align: center; word-wrap: break-word;'></td><td style='text-align: center; word-wrap: break-word;'></td><td style='text-align: center; word-wrap: break-word;'></td></tr><tr><td style='text-align: center; word-wrap: break-word;'></td><td style='text-align: center; word-wrap: break-word;'></td><td style='text-align: center; word-wrap: break-word;'></td><td style='text-align: center; word-wrap: break-word;'></td><td style='text-align: center; word-wrap: break-word;'></td><td style='text-align: center; word-wrap: break-word;'></td></tr><tr><td style='text-align: center; word-wrap: break-word;'></td><td style='text-align: center; word-wrap: break-word;'></td><td style='text-align: center; word-wrap: break-word;'></td><td style='text-align: center; word-wrap: break-word;'></td><td style='text-align: center; word-wrap: break-word;'></td><td style='text-align: center; word-wrap: break-word;'></td></tr><tr><td style='text-align: center; word-wrap: break-word;'></td><td style='text-align: center; word-wrap: break-word;'></td><td style='text-align: center; word-wrap: break-word;'></td><td style='text-align: center; word-wrap: break-word;'></td><td style='text-align: center; word-wrap: break-word;'></td><td style='text-align: center; word-wrap: break-word;'></td></tr><tr><td style='text-align: center; word-wrap: break-word;'></td><td style='text-align: center; word-wrap: break-word;'></td><td style='text-align: center; word-wrap: break-word;'></td><td style='text-align: center; word-wrap: break-word;'></td><td style='text-align: center; word-wrap: break-word;'></td><td style='text-align: center; word-wrap: break-word;'></td></tr><tr><td style='text-align: center; word-wrap: break-word;'></td><td style='text-align: center; word-wrap: break-word;'></td><td style='text-align: center; word-wrap: break-word;'></td><td style='text-align: center; word-wrap: break-word;'></td><td style='text-align: center; word-wrap: break-word;'></td><td style='text-align: center; word-wrap: break-word;'></td></tr><tr><td style='text-align: center; word-wrap: break-word;'></td><td style='text-align: center; word-wrap: break-word;'></td><td style='text-align: center; word-wrap: break-word;'></td><td style='text-align: center; word-wrap: break-word;'></td><td style='text-align: center; word-wrap: break-word;'></td><td style='text-align: center; word-wrap: break-word;'></td></tr></table>

1. I must met with my VA coordinator each semester to update my file and have an advisement session every 30 days

2. I must report any changes in my enrollment at Kentucky State University to my VA coordinator immediately.

3. I must seek a program/major of study by the end of my second semester to continue my VA benefits.

4. I will ensure the courses I take are required or can be used as electives in my program of study.

5. I understand taking a course that is not part of my curriculum sheet and not approved by my department; the VA office will not be responsible for payment

6. If a course has been substituted for another course, I must have a course substitution form signed by my advisor and provide a copy to my VA coordinator.

7. If an add/drop from has been signed b my advisor for a course, I must provide a copy to my VA coordinator.

8. If taking classes through another University I must have the visiting student form approved by my advisor and department chair and provide a copy to my VA coordinator.

9. I understand failure to report any changes to my enrollment will result in restrictions/reimbursements from VA in the future.

VA Students Signature



___

Date



2023

Date