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Hello,

You are about to fill out the Norwich University VA Benefits Enrollment/Certification Online Form. All of your answers are considered confidential and will not be publicized in any way. If you have any questions about this form please contact Judy Sassi, Assistant Registrar, College of Graduate and Continuing Studies, at [email protected] or 1-802-485-2255.

We thank you for choosing Norwich.

* What is your last name?

* What is your first name?

What is your student ID number? At Norwich, the student ID number is known as the A Number (A00XXXXXX).

* For which benefit are you eligible?

* For which session would you like an enrollment certification submitted?

Session A --- August 31 to October 24

Session B --- October 25 to December 19

Do you plan to use Tuition Assistance in conjunction with your VA benefits?

Yes, in both sessions.

Yes, but only in session A.

Yes, but only in session B.

I do not plan to use TA.

* I understand I am responsible for ALL charges not covered by my VA benefits.

Yes

No

* I understand that I may be liable for any over payment I receive from the VA.

Yes

No