Veteran Affairs Certification Request

UMID *

Name*

First Name

Initial (optional)

Last Name

Date of Birth*

Email*

Phone*

Sponsoring Branch of Service*

Air Force Army Coast Guard Marine Corps Navy Space Force Army National Guard Air National Guard

College

College of Arts, Sciences, and Letters College of Business College of Education, Health, and Human Services College of Engineering and Computer Science PDS Guest

Major*

TERM*

Registered Course

E.G.: 21150, MATH 105, 001

Registered Course

E.G.: 21150, MATH 105, 001

Registered Course

E.G.: 21150, MATH 105, 001

Registered Course

E.G.: 21150, MATH 105, 001

Registered Course

E.G.: 21150, MATH 105, 001

Registered Course

E.G.: 21150, MATH 105, 001

Which benefit are you eligible to receive?*

Chapter 30 - Montgomery GI Bill - Active Duty Chapter 31 - Vocational Rehabilitation & Employment Chapter 32 - Veterans Educational Assistance Program Chapter 33 - Post 9/11 GI Bill Chapter 33 - Post 9/11 GI Bill DEPENDENT Chapter 33 - Post 9/11 GI Bill STEM Chapter 35 - Survivors & Dependent Education Assistsance Chapter 1606 - Montgomery GI Bill Selected Reserve

Check if you are receiving :*

Reserve Officer Training Corp (ROTC) Scholarship Military Spouse Career Advancement Account (MyCAA) Health Professionals Scholarship Program (HPP) Government Employees Training (GETA) Federal Military Tuition Assistance (TA) State Military Tuition Assistance (MINGSTAP) Other Military of Federal Tuition Assistance (TA)- Please Describe in "Other' field None of the Above

Other:

I certify that the above information is accurate, and I acknowledge the fact that I must personally notify the Veteran Affairs Coordinator immediately if I make any changes in the above elections. I certify that all courses are applicable to my degree program and meet VA requirements. I further understand that any information on this form or in my University record may be shared with the VA at its request.

CAUTION: Carelessness in filling out this form, lack of complete information, or failure to report subsequent changes may result in delayed allowance or loss of benefits.

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