LARAMIE COUNTY COMMUNITY COLLEGE Other Name (Last, First M.I.) Date of Birth Zip Code Address Type of Major AS (please check one) First time – “I have never used my Name Eagles of Eye Major Email (will only send info from school to this address) Home Student Street Education Certification Are Chapter Chapter Chapter Chapter Chapter Address you ID Benefit Number using Status 33 30 35 1606 1607 Being (Post-9/11 (Dependent (Montgomery (please (Active (REAP) Applied check Guard Reserve For GI one or Bill) (please GI Spouse and Tuition Bill) TRANSFER or complete check National from one) any a Overseas OF Guard) deceased additional Cell Social ENTITLEMENT Phone Security Combat information, vet Number or 100% ** if needed) disabled MyCAA AA City vet), ** DVR AAS State Only” Source ex Chapter Transferring- education 31 benefits (VA Voc have and Rehab) used would my benefits like to begin at a different using them.” school and want to transfer to LCCC” Chapter Continuing Reinstating 33 (Post-9/11 have have attended attended GI Bill) VETERAN and and used used my my benefits benefits at at LCCC LCCC but but have has been changed a year my or major.” longer.” “Tuition – – “I “I “I please provide the claim number or the vets social security number: ______________________ scholarship Assistance Transferring have Branch of Service Coast Guard Air Force Navy Marines Army – “I used my education Active Duty Reserve Veteran Spouse Dependent benefits at a different **For those using parent’s/spouse’s education benefits, please list entry date and, if school and applicable, exit date of service** want to transfer to LCCC.” 1400 E College Dr. 1125 Boulder Dr. Cheyenne, WY 82007 Laramie, WY 82070
Name (Last, First M.I.) Student ID Number Social Security Number Date of Birth Street Address City State Zip Code Home Cell Phone Address Eagles Eye Email (will only send info from school to this address) Name of Major Type of Major (please check one) AA AAS AS Education Benefit Being Applied For (please check one) Chapter 33 (Post-9/11 GI Bill) VETERAN Chapter 33 (Post-9/11 GI Bill) TRANSFER OF ENTITLEMENT ** Chapter 30 (Montgomery GI Bill) Chapter 35 (Dependent or Spouse from a deceased vet or 100% disabled vet), ** please provide the claim number or the vets social security number: ______________________ Chapter 1606 (Active Reserve or National Guard) Chapter 1607 (REAP) Chapter 31 (VA Voc Rehab) Certification Status (please check one and complete any additional information, if needed) First time – “I have never used my education benefits and would like to begin using them.” Continuing – “I have attended and used my benefits at LCCC but have changed my major.” Reinstating – “I have attended and used my benefits at LCCC but has been a year or longer.” Transferring – “I have used my education benefits at a different school and want to transfer to LCCC.” Transferring- “I have used my benefits at a different school and want to transfer to LCCC” Are you using Guard Tuition Assistance Overseas Combat MyCAA DVR Other “Tuition Only” Source ex scholarship Branch of Service Coast Guard Air Force Navy Marines Army Active Duty Reserve Veteran Spouse Dependent **For those using parent’s/spouse’s education benefits, please list entry date and, if applicable, exit date of service** LARAMIE COUNTY COMMUNITY COLLEGE 1400 E College Dr. 1125 Boulder Dr. Cheyenne, WY 82007 Laramie, WY 82070