Veteran's Statement of Responsibility

VA Benefits intake form. Necessary to process VA benefits.

1Personal Information > 2Disclaimers > 3Signature
Name Name First Last
Email

Confirm Email Address
Contact Phone Number Contact Phone Number - ### - ### ####
G00
Social Security Number
Must be 9 digits. Currently Entered: 0 digits.
Please enter in your full 9 digit Social Security Number here (e.g. 123456789)
Date of Birth Date of Birth / MM / DD YYYY
Mailing Address Mailing Address
Street Address Address Line 2 City State / Province / Region Postal / Zip Code Country
College Major
Have you ever attended Imperial Valley College before?
Have you received V.A. Educational Benefits at Imperial Valley College before?
Last Semester You Received Benefits
Last Year You Received Benefits
Must be a number between 1900 and 2100
List all colleges previously attended, whether or not you have received benefits. Include year and dates attended.
Total number of all prior college units completed to date:
Are you changing majors this semester?
Will this be your last semester at Imperial Valley College?
Your submission must include a DD-214 Member 4 and Certificate of Eligibility for VA Intake to be processed (Unless you've previously provided one in the past and we have it on file already). For any questions call the Military & Veteran Success Center at (760) 355-6141.
Military Status

Military Status Active Duty Reserve/ National Guard Veteran Dependent
Have you submitted a DD-214 Member 4 with IVC before?
Upload your DD-214 Member 4

Attach Files
Have you submitted a Certificate of Eligibility with IVC before?
Upload your Certificate of Eligibility

Attach Files

Veteran's Statement of Responsibility

Veteran's Statement of Responsibility

Your submission must include a DD-214 Member 4 and Certificate of Eligibility for VA Intake to be processed (Unless you've previously provided one in the past and we have it on file already). For any questions call the Military & Veteran Success Center at (760) 355-6141.