VA Certification Request Form

First / Last name

Student ID Number

Address

Phone

Email address

Please indicate the type of certification requested:

New Schedule

Added Courses

Dropped Courses

Please indicate which upcoming semester you would like to receive VA Benefits:

Fall

Spring

Summer

Check type of benefits:

Chapter 30 Montgomery G.I. Bill

Chapter 32 VEAP

Chapter 33 Post 9/11 (Starts 09/FA, 09/T1)

Chapter 1606 Selected Reserves Montgomery GI Bill

Chapter 1607 REAP

Chapter 31 VOC. Rehab

Chapter 35 Dependents Education Assistance

If you selected Chapter 31 Voc Rehab, please provide your Voc Rehab Counselor name and email:

If you selected Chapter 35 Dependents Education Assistance, please provide your VA file name

Are you currently on active duty? (Required for CH 30, CH 1606, CH 1607, and Post 9/11)

Yes

If yes, are you using tuition assistance (TA)? (Applies to CH30, CH 1606, CH 1607, and POST 9/11 on Active Duty only)

Yes

Are you a transient Student (are you taking courses here to apply towards a degree at another college)?

Yes

If yes, what is the name of the parent school?

(Transient students must provide written authorization from their parent school to enroll in specific courses before benefits can be processed.)If Yes, have you provided transient authorization?

Yes

STUDENT CERTIFICATION

I will promptly report changes to my schedule to the appropriate UM VA Certifying Official such as DROPS, WITHDRAWALS and ADDING COURSES.

I understand I can only be certified for courses listed on my program of study.

I understand I cannot be certified for courses for which I have already received credit.

If I am CH 30, CH 1606, CH 1607, and Post 9/11 on Active Duty, I understand I cannot be certified for courses for which I am receiving Tuition Assistance (TA).

I will promptly report changes to my schedule to the appropriate UM VA Certifying Official such as DROPS, WITHDRAWALS, AND ADDING COURSES.

If you agree with the above statements, please enter your full name in the field below.

First / Last name

Date

YYYY

Verification