VA Work-Study Program Interest Form

VA Work-Study Program Interest Form - Returning Student

Student Information

First Name

Last Name

CSUSM Email: (Example: jdoe001@cougars.csusm.edu)

What term/year is this program request for?

Expected Graduation Term:

Expected Graduation Year:

Number of units enrolled and certified in under VA Education Benefits:

Requested Schedule Information

What is the total number of hours per week requested? Note: The Max number of hours student is allowed to request during the semester is (20) per week. If this is a zero-hour extension request, student is allowed to request up to (40) per week.

Please use military time format in the following fields. If you are requesting multiple start and end times for one day, use the following format and separate with comma: [ 0800-1130, 1430-1700 ]

- If you are not requesting hours for a selected day of the week, please enter "N/A" and "0" for Total Daily Hours.

Please do not request any times that you are already scheduled for classes.

Monday: Start time - End time

Total Daily Hours

Tuesday: Start time - End time

Total Daily Hours

Wednesday: Start time - End time

Total Daily Hours

Thursday: Start time - End time

Total Daily Hours

Friday: Start time - End time

Total Daily Hours

Additional Information

Attach a copy of requested term/year class schedule:

Please check your email for conformation of this request. Thank you!

Comment or Message:

Contact Information