Enrollment Certification Request
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2AMERICAN UNIVERSITY VA ENROLLMENT CERTIFICATION REQUEST
This form must be completed and submitted each semester VA benefits are utilized
This form is:
____The initial Form for Current Semester
____An Updated Form
AU ID:________________
AU Email Address:____________________________________________
DEMOGRAPHICS
LAST NAME:_____________________________ FIRST NAME_________________________________MI:____
CURRENT ADDRESS:_______________________ CITY:__________________STATE:______ZIP CODE:________
CONTACT NUMBER:_______________________
MILITARY STATUS
ACTIVE DUTY____ RESERVIST____ VETERAN____ NATIONAL GUARD____ DEPENDENT____ SPOUSE____
BRANCH:
ARMY ____ AIR FORCE ____ COAST GUARD____ MARINES____ NAVY____
***Please Note: Spouses of active duty service members who are receiving transferred benefits are not eligible for the Yellow
Ribbon Program
VETERANS EDUCATIONAL BENEFITS FOR WHICH YOU ARE APPLYING
30-MGIB____ 31-VOC REHAB____ 33 POST 9/11____ 33-YELLOW RIBBON____
35-DEPENDENT /SPOUSE____ 1606-SPEC. RES.____ 1607-REAP____ 34-VIETNAM ERA____
PERCENTAGE OF ENTITLEMENTS_____%
ENROLLMENT INFORMATION
NUMBER OF CREDITS REGISTERED FOR THIS SEMSTER:____
ACADEMIC YEAR REGISTERED:_______
SEMESTER REGISTERED: FALL____ SUMMER____SPRING____
STUDENT STATUS:
NEW STUDENT____ TRANSFER____ RETURNING____ GUEST____
DEGREE OBJECTIVE: BA___ BS____ MA____MFA____PhD. ____ JD____ NON DEGREE_____
SCHOOLS/COLLEGES: CAS____KSB____SIS____SOC____SPA____WCL____SPeXs____
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