Enrollment Certification Request - Georgian Court University printable pdf download

OFFICE USE ONLY

Request for Veteran Enrollment Certification

Date Received ______________

Cert Completed _____________

 Main Campus

 Grad

Name ______________________________________________________________

 Communiversity  DU/G

 YRP _______

GCU ID _______________ Term ________________________________________

Phone Number______________________________ E-Mail ___________________________________________________

Mailing Address _______________________________________________________________________________________

Is this a change in degree since your last certification?  Yes  No

Degree/Major ____________________________________

If so, you must attach VA form 22-1995.

Check the VA Educational Benefit You Are Claiming:

 Chapter 30 (Montgomery GI Bill)

 Chapter 31 (Vocational Rehabilitation)

 Chapter 33 (Post-9/11 GI Bill)

 Chapter 35 (Survivor/Dependent DEA)

 Chapter 1606 (Reserve National Guard)  Chapter 1607 (REAP)

Check If Any of the Following Apply:

 Are you currently on active duty or active orders?

 Is this your first enrollment for this chapter of VA

 Are you receiving any military TA, ROTC, or MyCAA funds for this term?

benefits? (If so, attach your Certificate of Eligibility

 Have you separated since last term? (attach DD-214)

and Copy of Application for Benefits)

 Are you eligible and applying for the Yellow Ribbon Program?

 Have you changed schools (transferred) since your

 Will you be separating this term? ETS _______________________

last certification? (If so, attach VA form 22-1995)

 Are you concurrently enrolled at another school? Other school _____________________________________________

If concurrent, GCU is your  Parent

 Secondary

Registered Courses

Credits

Required?

Repeat?

Campus/

(e.g., History of Ireland HI354)

(Yes or No)

Online

Name of Academic Advisor

By signing this form, I affirm that the information I have provided is accurate, and I understand that:

1. all of the above-listed courses are eligible for certification to the VA and are required for my degree program;

2. it is my responsibility to notify the GCU VA coordinator of any changes to my registration (adds/drops), tuition, or fees;

3. if I drop or fail a course, I may be required to repay the benefits I have received (including housing) for the course; and

4. I am personally obligated to pay any debts to the university resulting from reductions or terminations of enrollment or veteran

benefit eligibility regardless of original method of payment.

Student Signature __________________________________________________________ Date ______________________________

We cannot accept this form without your signature, and you will not be certified for VA benefits without this form. It is your

responsibility to submit and verify receipt of this form every semester or term for processing. You may print, sign, and e-mail this

form, with all requested attachments, to financialaid@georgian.edu. You may also fax to, mail to, or drop it off at the

Office of Financial Aid. You will receive an e-mail confirmation when your certification is sent to the VA.

Enrollment Certification Request - Georgian Court University

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