Veteran Fact Sheet – SUNY Polytechnic Institute Forms

Student's Name *

First Last

SUNY Poly ID# *

Please include the "U00" in addition to the last 6 digits.

YEAR of request *

Please enter the 4-digit year that you would like to use your benefits

Semester/Term of Request *

Please select the term you would like to use your benefits

ANTICIPATED OR ACTUAL NUMBER OF CREDITS REGISTERED FOR THIS TERM: *

For which part(s) of the fall term are you registered? *

Please check any/all that apply

Your Email address *

Emails from the Registrar's Office will always be sent to your SUNY Poly email account.

Home Address *

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Local/Campus Address (if any)

If you do not have a local/campus address, please leave blank.

Street Address Address Line 2 City State ZIP Code

Primary Phone

Cell/Mobile Phone

Level of Study *

Do you plan to graduate at the end of this semester? *

Type of Student *

NEW Students: What is the name of the last college you attended? *

NEW Students: When did you last attend that college? *

NEW Students: Did you collect VA benefits at that institution? *

RETURNING/CONTINUING Students: When did you last attend SUNY Poly? *

VA File # *

Benefits Received *

Montgomery Bill Clarification *

If you indicated that you are receiving benefits under Chapter 30 (Montgomery Bill):

By submitting this form electronically, I am affirming the following:

I intend to take the above listed number of credit hours and
Any and all changes that I make to any of the information submitted will be promptly reported by me to the Veterans' Certifying Official in the Registrar's Office at SUNY Polytechnic Institute and
I realize that I will be personally responsible for the submission of monthly attendance reports in accordance with the school and Veterans Administration regulations.

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Phone

This field is for validation purposes and should be left unchanged.