Veteran Request for Enrollment Certification
| Please return to: | Indiana State University | Please indicate the semester for which you wish to be certified: |
| Office of Registration and Records | ||
| Parsons Hall Room 009 | ___Fall Year: _____ ___Summer 1 Year: _____ | |
| Terre Haute IN 47809 | ___Spring Year: _____ ___Summer II Year: _____ | |
| Phone: (812) 237-4996 Fax: (812) 237-8039 | Chapter 33 applicants cannot be certified for more than one semester at a a time due to new federal regulations. You must complete a new enrollment certification for each semester or term in which you register | |
| Name: | ______________________________________________ | V A File #: _______________________________ |
| Street Address: | ______________________________________________ | E-mail address: __________________________ |
| City, State, Zip Code: | ______________________________________________ | Telephone No.: __________________________ |
Which VA Education Benefit Program are you requesting to be certified under this semester? Please visit the www.gibill.va.gov website to learn which education benefit is best for you.
| ______ | (Chapter 30) Montgomery (Active Duty) G I Bill |
| ______ | (Chapter 31) Vocational Rehabilitation |
| ______ | (Chapter 1606) Montgomery (Reserve/National Guard) G I Bill |
| ______ | (Chapter 35) Spouse/Dependent of Veteran G I Bill VA Claim Number: ___________________ |
| ______ | (Chapter 1607) Montgomery (Reserve/National Guard Active Duty) G I Bill |
| ______ | (Chapter 33) Post 9/11 G I Bill Is this for Transfer of Entitlement? ___Yes ___No Do you wish to apply for the Yellow Ribbon Program if 100% eligible? ____Yes ____No |
| 1. | Have you ever been certified under this VA Education Benefit Program before? ____ If you answered "yes" which institution(s) did you attend? _____________ _____________ Are you in an overpayment status? __No __Yes If you answered 'yes', have you contacted the Debt Management Center of the VA to make payment arrangements? __No __Yes |
| 2. | What is your current degree objective? ___________________ (B.S., B.A., M.S, etc) Major________________ |
| 3. | Have you changed majors since your last VA enrollment certification? _____ Yes _____ No If yes, you must contact the VA Certifying Official. |
| 4. | How many hours are/will you be enrolled in for the semester/term requested? _____Fall ____Spring ____Summer I ____Summer II |
| 5. | Are you repeating any classes? _____Yes ______ No If so, which ones? ____________ _____________ ____________ |
**ALL COURSE WORK MUST BE REQUIRED FOR THE DEGREE IN ORDER TO USE VA BENEFITS
**FOR ALL FAILING GRADES, THE INSTRUCTOR WILL BE CONTACTED FOR LAST DATE OF ATTENDANCE
Change in course enrollment after certification has been submitted to the VA may result in the retroactive loss of benefits unless the VA finds mitigating circumstances involved in the change. Loss of benefits could revert back to the first day of class.
I AM AWARE THAT CHANGES IN MY REGISTRATION MAY ALTER THE PAYMENT THE VA WILL AWARD ME. I understand that I will be liable for any overpayment I might receive from the Veterans Administration. I also understand that I must notify the VA Certifying Official of any changes in registration, in addition to the Veteran's Affairs Administration. I AM ALSO AWARE THAT I MUST COMPLETE THIS FORM FOR EACH SEMESTER/TERM I WISH TO BE CERTIFIED, ONCE I AM REGISTERED FOR THAT SEMESTER/TERM.
I hereby certify that all statements are true and complete to the best of my knowledge and belief.
| Signature: | Date: |
ADVANCE PAY REQUEST (NOT AVAILABLE FOR CHAPTER 33)
I understand that this check would be for the first two months of the semester. I hereby request the Veterans Administration to issue to me Advance Pay for the ___________ semester of the year ___________.
| Signature: | Date: |