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School Certification for Veteran Students

This form must be filled out each term of enrollment. Failure to complete this form fully will cause a delay in processing your enrollment verification and monthly G.I. benefits.
 
First Name*
Middle Name
Last Name*
Student ID#
Address*
City*
State*
Zip code*
Daytime phone*
Email address*
Date of Birth (MM/DD/YYYY)
Degree program*
Number of Credits enrolled per term
Period of Enrollment
Are you taking classes at the Grand Forks Air Force Base
VA Chapter
Are you attending another Institution now?
If yes, which Institution?
Have you used VA benefits at another Institution?
If yes, have you filed VA Form 22-1995?
 

If you have filed VA Form 22-1995, please provide a copy to Lake Region State College.  Either

Email: lrsc.registrar@lrsc.edu

Mail to:  Lake Region State College
             Attn: Registrar Office
             1801 College Drive N
             Devils Lake, ND 58301