Student Administrative Services Veteran'S Certification Form printable pdf download

TUDENT

DMINISTRATIVE

ERVICES

’

ETERAN

ERTIFICATION

ORM

• 3225 F

, B

9 • C

• I

• 60625

ORTH

ARK

NIVERSITY

OSTER

HICAGO

LLINOIS

: 773-244-5560;

: records@northpark.edu;

: 773-634-4051

PHONE

FAX

Please complete this form for each semester that you are enrolled at NPU and using Federal VA Benefits

Name: ___________________________________________________________________

Social Security Number: _______________________________________________________

Address: ________________________________________________________________

City, State, Zip: _________________________________________________________________

Are you (or will you be) on Active

 Yes

 No

Are you a visiting student?

 Yes

 No

Duty during the semester?

If Yes, Primary School: ___________________________________________________________

If Yes, approximate date of call-up: __________________________

VA Benefit Type

Enrollment Information



Post-9/11 GI Bill (Chapter 33) _______________%

Continuing (Last VA



No Additional Forms Required

Montgomery GI Bill (Chapter 30)

payment at NPU)



MGIB Selected Reserve (Chapter 1606)

Complete

VONAPP

(or

VA Form

Transfer (Last VA payment



Reserve Educational Assistance (Chapter 1607)



22-1995) and submit copy of

at another school)

“Certificate of Eligibility”

Survivors and Dependents (Chapter 35)

Must submit “Primary School”



Visiting (VA benefits based



File #: ______________________________________________

letter from home school’s VA

at another school)

certifier



Complete

VONAPP

(or

VA Form

Vocational Rehab (Chapter 31)

New (Have not yet used VA



22-1990) and submit copy of

Other:

benefits)

“Certificate of Eligibility”



Certifying Semester



Fall Semester

Spring Semester

Summer Semester

Year: __________________________

By signing this form, I understand and accept the following terms of this certification:

I understand that if accepting Chapter 31 benefits that a completed VA 28-1905 form from my counselor must be submitted to the School

Certifying Official stating what educational costs the VA will cover. Additionally, I understand that I will be responsible for all charges

that the VA does not cover through this program.

I understand that I must submit a copy of my DD-214, Certificate of Eligibility and, if applicable, official transcripts from all my previous

colleges (or for military experience credit) to NPU to be evaluated for transfer credit. If two semesters pass and I have not provided

previous official transcripts to NPU, I understand that I can no longer be certified for educational benefits with the VA unt il prior credits have

been evaluated and posted to my academic record.

I understand that by receiving Veteran’s Benefits, I must maintain satisfactory academic progress. I understand that each semester my

academic record will be evaluated according to federal regulations. The first semester that I do not meet satisfactory academ ic progress, I

will receive a warning. If my academic standing is unsatisfactory the following semester, I understand that my VA benefits will be suspended,

but that I will have the right to appeal to the Director of Financial Aid.

I understand it is my responsibility as the student to notify NPU’s VA Certifying Official of any changes I make at any time, including

address, intended major, dropped or added classes, or complete withdrawals (including withdrawal due to Active Duty call-up).

I understand that dropping a class, receiving a grade of W, or repeating a class may result in reduced payment from the VA and the VA will

hold the student responsible for any overpayment of benefits and/or outstanding charges/balances to NPU.

I am aware that if I withdraw from my course(s) and receive a non-punitive (W) grade, I may be required to make partial or complete

repayment of my GI Bill educational benefits for the semester. If I withdraw from the University or receive F’s due to non-attendance, I may

be required to repay a portion or all of my educational benefits.

The VA will only approve benefits for courses that are required to complete my VA approved program of stud y as listed in the NPU

University Catalog. The VA will not approve benefits for audited courses, remedial courses, or for me to retake courses that I have already

successfully completed.

(See reverse side)

Rev 6/14

Student Administrative Services Veteran'S Certification Form

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