Veteran Fact Sheet Students wishing to use veterans' benefits must submit this form each semester. Student's Name * Required First Last SUNY Poly ID# * RequiredPlease include the "U00" in addition to the last 6 digits. YEAR of request * RequiredPlease enter the 4-digit year that you would like to use your benefits Semester/Term of Request * RequiredPlease select the term you would like to use your benefits Fall Spring Summer ANTICIPATED OR ACTUAL NUMBER OF CREDITS REGISTERED FOR THIS TERM: * RequiredFor which part(s) of the fall term are you registered? * RequiredPlease check any/all that apply Full Term (15 weeks) Part of Term 2 (First 7 weeks) Part of Term 3 (Second 7 weeks) Your Email address * RequiredEmails from the Registrar's Office will always be sent to your SUNY Poly email account. Home Address * Required Street Address Address Line 2 City State / Province / Region ZIP / Postal Code AfghanistanAlbaniaAlgeriaAmerican SamoaAndorraAngolaAnguillaAntarcticaAntigua and BarbudaArgentinaArmeniaArubaAustraliaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBermudaBhutanBoliviaBonaire, Sint Eustatius and SabaBosnia and HerzegovinaBotswanaBouvet IslandBrazilBritish Indian Ocean TerritoryBrunei DarussalamBulgariaBurkina FasoBurundiCambodiaCameroonCanadaCape VerdeCayman IslandsCentral African RepublicChadChileChinaChristmas IslandCocos IslandsColombiaComorosCongo, Democratic Republic of theCongo, Republic of theCook IslandsCosta RicaCroatiaCubaCuraçaoCyprusCzech RepublicCôte d'IvoireDenmarkDjiboutiDominicaDominican RepublicEcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEswatini (Swaziland)EthiopiaFalkland IslandsFaroe IslandsFijiFinlandFranceFrench GuianaFrench PolynesiaFrench Southern TerritoriesGabonGambiaGeorgiaGermanyGhanaGibraltarGreeceGreenlandGrenadaGuadeloupeGuamGuatemalaGuernseyGuineaGuinea-BissauGuyanaHaitiHeard and McDonald IslandsHoly SeeHondurasHong KongHungaryIcelandIndiaIndonesiaIranIraqIrelandIsle of ManIsraelItalyJamaicaJapanJerseyJordanKazakhstanKenyaKiribatiKuwaitKyrgyzstanLao People's Democratic RepublicLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacauMacedoniaMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMartiniqueMauritaniaMauritiusMayotteMexicoMicronesiaMoldovaMonacoMongoliaMontenegroMontserratMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNew CaledoniaNew ZealandNicaraguaNigerNigeriaNiueNorfolk IslandNorth KoreaNorthern Mariana IslandsNorwayOmanPakistanPalauPalestine, State ofPanamaPapua New GuineaParaguayPeruPhilippinesPitcairnPolandPortugalPuerto RicoQatarRomaniaRussiaRwandaRéunionSaint BarthélemySaint HelenaSaint Kitts and NevisSaint LuciaSaint MartinSaint Pierre and MiquelonSaint Vincent and the GrenadinesSamoaSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSint MaartenSlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSouth GeorgiaSouth KoreaSouth SudanSpainSri LankaSudanSurinameSvalbard and Jan Mayen IslandsSwedenSwitzerlandSyriaTaiwanTajikistanTanzaniaThailandTimor-LesteTogoTokelauTongaTrinidad and TobagoTunisiaTurkeyTurkmenistanTurks and Caicos IslandsTuvaluUS Minor Outlying IslandsUgandaUkraineUnited Arab EmiratesUnited KingdomUnited StatesUruguayUzbekistanVanuatuVenezuelaVietnamVirgin Islands, BritishVirgin Islands, U.S.Wallis and FutunaWestern SaharaYemenZambiaZimbabweÅland Islands Country Local/Campus Address (if any)If you do not have a local/campus address, please leave blank. Street Address Address Line 2 City AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code Primary PhoneCell/Mobile PhoneLevel of Study * Required Undergraduate/Bachelor's Degree Graduate/Master's or Doctoral Degree Do you plan to graduate at the end of this semester? * Required Yes No Type of Student * Required I am a NEW student to SUNY Poly I am a CONTINUING student at SUNY Poly I am RETURNING to SUNY Poly after a readmission NEW Students: What is the name of the last college you attended? * Required NEW Students: When did you last attend that college? * Required NEW Students: Did you collect VA benefits at that institution? * Required Yes No RETURNING/CONTINUING Students: When did you last attend SUNY Poly? * Required VA File # * Required Benefits Received * Required VR & E (31) Post 9/11 GI Bill (33) Spouse/Child of a Disabled or Deceased Vet (35) Reservists (1606) REAP (1607) Montgomery Bill (30) Montgomery Bill Clarification * RequiredIf you indicated that you are receiving benefits under Chapter 30 (Montgomery Bill): I am also Former Chapter 34 (Vietnam Era) I am also Active Duty I am neither Active Duty nor Former Chapter 34/Vietnam Era 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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