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Clark State Name Change
Admissions
Enroll Now
Virtual Tour
Making Your Decision
General Admissions
Admissions For College Credit Plus
Admissions For Space-Limited Programs
Admissions For Military Students
Admissions For International Students
Admissions For Transfer/Visiting Students
Admissions For Online Students
Tuition and Fees
New Student Orientation
Placement Testing
Academic Advising
Credit for Life Experience
Transferring Credits
Consumer Information/Student Right to Know
Ask a Question
Financial Aid
Applying for Federal Financial Aid
Grants
Loans
Scholarships
Active Duty Military Benefits
Veterans Benefits
Summer Financial Aid
Financial Aid Forms
Return of Title IV Funds Policy
Standards of Satisfactory Academic Progress
Academics
Degrees and Certificates
Short-Term Training
Class Schedule
Class Schedule Planning
Types of Classes
Class Syllabi
Semester Dates
Academic Catalog
Ordering Textbooks
Library
Tutoring
Accessibility Services
Honors Program
Co-ops/Internships
Aspire High School Equivalency (HSE, including GED®)
Graduation
Request a Transcript
Youth Outreach Programs
Center for Teaching and Learning
Quick Path to Employment
Partnerships
College Life
Calendar
Athletics
Career Planning
Student Employment
Student ID
IT Help Center
Parking
Food Services
TRIO Student Support Services
Office of Student Support
Student Organizations
Student Handbook
Health and Wellness
Safety and Security
Counseling
Title IX
Report a Concern / Incident
About Us
Fast Facts
Locations
Contact Us
Employee Directory
Employment
Accreditations/Approvals
Board of Trustees
Meet the President
Mission, Vision, Guiding Principles
Strategic Planning
Alumni
Business Solutions
Foundation
Performing Arts Center
Community Room Rentals
National Science Foundation Education Zone Grant
Center for Cyber Defense Education Grant
News
Invitation to Bid
Coronavirus (COVID-19) Information
Clark State Name Change
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myClarkState
Financial Aid
VA Benefits Enrollment Reporting Request Form
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VA Benefits Enrollment Reporting Request Form
This form must be completed in its entirety each semester/term you register for classes before the School Certifying Official can report your enrollment in order for you to receive your GI Billâ„¢ benefits from the Veterans Administration (VA). If you have any questions, please contact the Veterans Services Specialist at 937.328.6462.
Full Name (first, middle, last) *
Clark State ID Number *
Street Address *
City *
State *
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Virgin Islands, U.S.
Virginia
Washington
West Virginia
Wisconsin
Wyoming
Zip Code *
Check this box if this a new address
Phone Number *
E-Mail *
First Enrollment for Semester/Term *
Yes
No
I added or withdrew from one or more classes *
Yes
No
Semester of Enrollment *
Future (TBD)
Spring
Summer
Fall
Clark State Major
Accounting
Accounting Certificate
Accounting Executive Option Departmental Certificate
Addiction and Recovery Services
Additive Manufacturing Short-Term Technical Certificate
Advanced Medical Coding Short-Term Technical Certificate
Agricultural Business
Agricultural Business - Agricultural Engineering Technology Option
Arts Administration Departmental Certificate
Associate of Arts
Associate of Arts - Healthcare Concentration Transfer
Associate of Arts - Honors Concentration
Associate of Science
Associate of Science - Healthcare Concentration Transfer
Associate of Science - Honors Concentration
Banking Departmental Certificate
Basic Peace Officer Academy
Business Transfer - Central State University
Business Transfer - Wright State University
Chemical Dependency Short-Term Technical Certificate
Clinical Medical Assisting Short-Term Certificate
Communication
Communication Departmental Certificate
Computer Networking
Computer Networking - Technical Systems Support Option
Computer Numerical Control (CNC) Short-Term Technical Certificate
Computer Programming Departmental Certificate
Computer Software Development
Computer Software Development - Cybersecurity Option
Computer Software Development - Web Development Option
Computer-Aided Design Departmental Certificate
Computer-Aided Design Technology
Consumer Lending Departmental Certificate
Criminal Justice Technology-Corrections Concentration
Criminal Justice Technology-Law Enforcement Concentration
Customer Service Short-Term Technical Certificate
CyberSecurity Short-Term Technical Certificate
CyberSecurity/Information Assurance Technology
Diesel Technology Program
Diesel Technology Short-Term Technical Certificate
Early Childhood Education
Electrocardiography Short-Term Technical Certificate
Emergency Medical Services
EMT Short-term Technical Certification
Firefighter / Transition Departmental Certificate
Firefighter / Volunteer Departmental Certificate
Firefighter I Short-Term Technical Certification
Firefighter II Short-Term Technical Certification
Food Science and Technology
Geospatial Precision Agriculture Specialist Short-Term Technical Certificate
GIS Analyst Short-Term Technical Certificate
GIS Image Analyst Short-Term Technical Certificate
GIS Programming Certificate
GIS/Geospatial Technology
Graphic Design
Health Information Technology Departmental Certificate
Heating, Ventilation, Air Conditioning, and Refrigeration (Clark County CTC)
Heating, Ventilation, Air Conditioning, and Refrigeration Departmental Certificate (Clark County CTC)
Horticulture Industries - Golf Course Operations Option
Horticulture Industries - Landscape Design Option
Horticulture Industries - Natural Resources Option
Horticulture Industries - Nursery Operations Option
Horticulture Industries - Turf and Landscape Operations Option
Human Resource Management Departmental Certificate
Industrial Maintenance Short-Term Technical Certificate
Industrial Technology
Information Services: Library Paraprofessional
Judicial Court Reporting
Judicial Court Reporting- Captioning/CART Career-Enhancement Certificate
Logistics and Supply Chain Management Departmental Certificate
Management
Management - Banking Option
Management - Human Resource Management Option
Management - Insurance Option
Management - Logistics and Supply Chain Management Option
Management - Marketing Option
Management - Real Estate Broker Option
Management Certificate
Manufacturing Departmental Certificate
Manufacturing Engineering Technology
Manufacturing Foundation Departmental Certificate
Manufacturing Technology Management - Computer-Aided Design Concentration
Manufacturing Technology Management - Industrial Technology Concentration
Manufacturing Technology Management - Manufacturing Engineering Technology Concentration
Manufacturing Technology Management - Mechanical Engineering Technology Concentration
Marketing Departmental Certificate
Mechanical Engineering Technology
Medical Assisting
Medical Assisting Certificate
Medical Coding Short-Term Technical Certificate
Medical Laboratory Technology
Multi-Skilled Healthcare Associate of Technical Studies
Multi-Skilled Healthcare Certificate
Network Administration Short-Term Technical Certificate
Network Infrastructure Short-Term Technical Certificate
New Media
New Media - Web Design Option
New Media Web Design Departmental Certificate
Nurse Aide Short-Term Technical Certificate
Occupational Therapy Assistant (Consortium Program)
Office Administration
Office Administration - Medical Office Administration Major
Paralegal
Paramedic Certification
Paramedic Certification for Registered Nurses
Patient Care Technician Short-Term Technical Certificate
Peer Recovery Support Short-Term Technical Certificate
Peer Support/Addictions & Recovery Short-Term Technical Certificate
Phlebotomy Short-Term Technical Certificate
Physical Therapist Assistant
Practical Nursing Certificate
Practical Nursing Certificate - Evening Weekend
Precision Agriculture
Precision Agriculture - Technician Option
Precision Agriculture Short-Term Technical Certificate
Professional Digital Editor Certificate
Professional Digital Reporter Certificate
Professional Office Administration Certificate
Professional Services Management
Property Insurance Claims Short-Term Technical Certificate
Radiographic Imaging (Consortium Program)
Real Estate Short-Term Technical Certificate
Registered Nursing
Registered Nursing - Evening / Weekend
Registered Nursing - LPN to RN Transition
Registered Nursing - Paramedic to RN Transition
Respiratory Care (Consortium Program)
Robotics Departmental Certificate
Small Business Departmental Certificate
Social Media Marketing Departmental Certificate
Social Services Technology
Social Work Transfer - Wright State University
Supervisory Control and Data Acquisition (SCADA) Departmental Certificate
Supervisory Departmental Certificate
Supply Chain Management Departmental Certificate
Teacher Education Transfer
Technical Support Short-Term Technical Certificate
Theatre Arts - Performance
Theatre Arts - Technical Theatre
UAS Operations and GIS Image Analysis Departmental Certificate
Web Design and Development - Web Design Concentration
Web Design and Development - Web Development Concentration
Web Development Departmental Certificate
Welding Short-Term Technical Certificate
Benefit Chapter/Name *
33-Post 9/11
30-MGIB-AD
31-VOCREHAB
1606-MGIB-SR
1607-REAP
35-DEA
If you are using the Post 9/11 benefit at what % is the benefit paid?
Are you on Active Duty? *
Yes
No
If yes, are you also receiving Military Tuition Assistance?
Yes
No
Do you receive any scholarships (including the Ohio National Guard Scholarship) or other assistance paying your tuition except Federal Financial Aid? *
Note: Failure to disclose scholarships and/or tuition assistance can result in an over payment or loss of benefits.
Yes
No
If yes, name of scholarship or source of assistance.
Check this box if you will graduate this term
By submitting this VA benefits enrollment request I am acknowledging that only classes required for my declared Clark State degree program(s) will be reported for my education benefits to the VA. My benefits will be based on the credit hours taken in required classes and the actual dates of enrollment.
I understand that if I add or withdraw from a class(es) after submitting this request it is my responsibility to notify the VA School Certifying Official by submitting an updated request.
I further acknowledge that if I fail to immediately notify the School Certifying Official when my schedule changes, I withdraw from a class and/or I stop attending a class, I may incur a debt with the VA for unearned benefits and/or with Clark State for unpaid tuition and fees.
Consent for storing submitted data *
Yes, I give permission to store and process my data