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Veteran Services



First Name
Last Name
UHD ID (900#)

S.S. #
Failure to disclose it may affect your ability to receive VA benefits in a timely manner.
S.S.# Parent/Spouse
Parent/Spouse S.S. # for Chapter 35 students ONLY


Zip Code
Telephone Number
  (must use gator email address)  

Current Degree Objective:
VA Chapter
If you are receiving Chapter 33 Post 9/11, please include the percentage
Has this changed since the last time you were certified? No Comments
  If yes, you will need to fill out additional documents.
Will you be graduating this semester? No example: switching chapters, emailing additional paperwork.

Applicant Status:  
  Last time certified
  Have you attended any other college since your last certification at UHD?
  If yes, list college(s)
Change of Schools; list prior college
  For the following enrollments, additional documents will be required
Transient enrollment (enrolled only at another institution)

Does your current enrollment include any of the following? If yes, list courses:
Deficiency Courses
Repeated Courses/Grade
Course Information:  
  Select the semester/session you are requesting certification and number of hours. You can only request one semester at at time.
Semester: Year: Hrs:

VA STUDENT RESPONSIBILITIES: Please initial by each statement.
  Since I am applying to receive VA Educational Benefits, I agree to:
  Register only for courses that are required for completion of my final objective and major
  Not register for courses for which I have previously received a passing grade
  Notify Veterans Services if I have changed my degree program
  Notify the VA Office Immediately if I:
  Change my course load
  Withdraw completely from my classes
  Am called to service, activated, or issued orders
Student's Electronic Signature



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Last updated or reviewed on 12/16/14

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