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Veteran Certification Request Form
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Veteran Services
Veteran Certification Request Form
Please fill out the form below
Veteran Certification Request Form
Student Information
VA File Number
*
Student ID
*
Date of Birth
*
First
*
First
Middle
Middle
Last
Last
Mailing Address
*
Mailing Address
Street Address
Street Address
Address Line 2
Address Line 2
City
City
State / Province
Alabama
Alaska
Arkansas
Arizona
California
Colorado
Connecticut
Delaware
District of Columbia
Florida
Georgia
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
Missouri
Montana
Nebraska
Nevada
New Hampshire
New Jersey
New Mexico
New York
North Carolina
North Dakota
Ohio
Oklahoma
Oregon
Pennsylvania
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
Vermont
Virginia
Washington
West Virginia
Wisconsin
Wyoming
State / Province
ZIP / Postal Code
ZIP / Postal Code
Email
*
Phone
*
I receive benefits under
*
New Montgomery (Chapter 30)
Vocational Rehabilitation & Employment (Chapter 31)
Post 9/11 (Chapter 33)
Survivor & Dependents (Chapter 35)
Reserves & National Guards (Chapter 1606)
REAP (Chapter 1607)
Academic Information
UMPI Degree Program
(if a degree candidate at UMPI)
Institution Name
(if NOT a degree candidate at UMPI)
Are you a new UMPI Student?
*
Yes
No
Semester of Certification
*
Fall -Regular semester
Fall – YourPace Session 1
Fall – YourPace Session 2
Spring -Regular semester
Spring – YourPace Session 1
Spring – YourPace Session 2
Summer -Regular semester
Summer – YourPace Session 1
Summer – YourPace Session 2
Credits Enrolled In
*
Are you taking classes off-campus or online at another institution?
*
Yes
No
Name of other institution
*
By submitting this form, I acknowledge my obligation to notify the School Certifying Official of any change in my course schedule. I understand that failure to do so will result in my being personally liable to the Veterans Administration for overpayments and could result in a delay of benefits for future semesters.
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Veteran Services
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Page Menu
Office of Student Records
Transcript Requests
Forms
Academic Appeals
Advanced Placement
CLEP
Confidentiality/FERPA
Degree Verifications
Graduation
International Baccalaureate
Request an Enrollment Verification
Register for a Class
State Authorization Reciprocity Agreements (SARA)
Veteran Services
Staff