VETS Online Claim Form

Submitting an Online Claim

Purpose:
To be used by students currently receiving veterans educational benefits at CSN, to report registered classes for certification to the Department of Veterans Affairs. First-time CSN students, students declaring a change of major, Supplemental Enrollment students, or students returning to CSN after an absence of longer than one year, should not use Online VA Claim Submission, but should contact the CSN Veterans' Affairs Office for instructions. For these students, additional documentation is required.

Important Reminder:
Students are sent letters reminding them of the need to have prior civilian and military education evaluated, and to have the evaluation results presented to the CSN VA Office. Failure to comply with this letter can prevent the processing of your claim.

Instructions for the following page:
To avoid processing delays, enter all information requested. To move from one question to the next, use the TAB key on your keyboard, or use your mouse cursor, (do not use the ENTER key at this time). List all class registrations for the semester. The form can be cleared at any time prior to submission by clicking the RESET button at the bottom of the form. When you are ready to submit your claim, depress the ENTER key on your keyboard, or click the SUBMIT button on the bottom of the form. Submit only after you have a confirmed enrollment in all desired courses. Feel free to contact the CSN Veterans' Affairs Office within a few days to confirm receipt of your submission.

E-Mail Notice:
Please include your e-mail address only if you are willing to accept electronic messaging as a means for this office to provide official correspondence to you.

Secure web page:
The Veterans' Affairs Office has added Secure Socket Layer (SSL) encryption technology so you can securely transmit your confidential Online Claim Form!

First Name:

Middle Initial:

Last Name:

Student ID #:

VA File #:

Address:

Apt. / Suite / Unit

City:

State:

Zip Code:

Daytime Phone #1:

Example: 702-999-8888

Campus Preference

Email Address:

Note: You MUST provide a current email address

Chapter:

Term:

Have you changed your address?

Active Duty:

If you are claiming benefits under Chapter 30 or Chapter 32, are you still on active duty?

Have you changed your major?

Important: If you answered YES to the Changing Major question above, you need to have your major declared in MyCSN effective for the semester in which you are claiming benefits and meet with a VA advisor before we can process your VA claim. If your new degree is non-health sciences, you can call 702-651-5060 to book an appointment with a VA advisor. Appointments open up for the following week every Monday and are first-come, first-served. If you are switching to a Health Sciences major, you are not required to meet with an advisor prior to processing your claim.

Courses
Subject Code ex: ENG	Course # ex:101	Title of Course	# Credits ex: 3	Is the class required for your CSN degree? ex: yes/no
Subject Code	Course Number	Course Title	Number of Credits	Class Required
Subject Code	Course Number	Course Title	Number of Credits	Class Required
Subject Code	Course Number	Course Title	Number of Credits	Class Required
Subject Code	Course Number	Course Title	Number of Credits	Class Required
Subject Code	Course Number	Course Title	Number of Credits	Class Required
Subject Code	Course Number	Course Title	Number of Credits	Class Required
Subject Code	Course Number	Course Title	Number of Credits	Class Required
Subject Code	Course Number	Course Title	Number of Credits	Class Required
TOTAL CREDITS CLAIMED FOR VA BENEFITS:			Total Credits

STATEMENT OF UNDERSTANDING:

I understand that I must contact the CSN Veterans' Affairs Office, each semester, AFTER I register, to continue the receipt of my benefits and that I must report any change in enrollment to CSN Veteran Affairs Office. (It is best to register early, if possible, so your claim can be processed at the earliest possible date)
I understand I must submit a degree plan for my chosen course of education leading to a standard college degree or certificate and have all prior training evaluated by the end of my second full-term semester. This evaluation result must be presented to the CSN Veterans' Affairs Office. I do not expect to be paid by the VA for courses previously passed or for courses not required for my chosen objective or major, and that I must make satisfactory progress toward graduation to continue receipt of benefits.
I understand that a grade of "W" or "I" may result in reduced payment from the VA and that the VA will not pay for audit classes. I further understand that a grade of "I" must be completed within one year to prevent its conversion to a failing (F) grade.
I understand that courses of other-than-normal semester term length may be paid at a different rate based on the number of credits and length of the course.
I understand the VA will hold me responsible for any overpayment of my educational benefits. In accordance with the Privacy Act of 1974 (Public Law 93-579), I authorize official representatives of the College of Southern Nevada to review and discuss my record concerning educational benefits with official representatives of the Department of Veterans' Affairs.
I understand that benefit payments are always paid one month in arrears and initial payment of benefits may sometimes be delayed depending on the CSN VA and Regional Processing Offices' workloads.
I understand that by submitting this form electronically, I certify, to the best of my knowledge, that all the information entered is true and that I have read, understand and agree to all conditions listed above.

Please, do not submit more than one claim for the same semester!