Enrollment Certification Request for Veteran/Military Benefits
*This form must be submitted to the Certifying Official each semester to be certified for benefits.
I. Personal Information
First/Last Name _________________________________________ EMPLID __________________
II. Academic Information
Are you a new student at John Jay? __ Yes __ No
Degree __ Bachelor __ Masters __ Certificate Major _____________________________
Major Specialization or Concentration(s) __________________________________________
III. Enrollment Certification Information
1. Please select your current branch of service
__ Air Force
__ Army
__ Coast Guard
__ Marine Corps
__ Navy
Are you currently serving Active Duty? __ Yes __ No
2. Please select benefit(s) requested
__ Chapter 30 – Montgomery GI Bill® AD
__ Chapter 31 – Veteran Readiness and
Employment (VR&E)
__ Chapter 33 – Post 9/11
__ Chapter 33 STEM Scholarship
__ Chapter 35 – Survivors’ & Dependents’
__ Chapter 1606 – Reserve/National
__ RIRP/Naval Militia
__ Federal Tuition Assistance
__ NYS Veterans Tuition Award
__ MYCAA Scholarship
3. Academic year __________ Check semester(s) you are enrolled and wish to be certified
__ Summer 3 week Session 1
__ Summer 3 week Session 2
__ Summer 3 week Session 3
__ Summer 5 week Session 1
__ Summer 8 week Session 1
__ Fall Regular Session
__ Fall 8 Week Session 1
__ Fall 8 Week Session 2
__ Winter
__ Spring Regular Session
__ Spring 8 Week Session 1
__ Spring 8 Week Session 2
__ Summer 5 week Session 2
Chrissy Pacheco – Assoc. Dir./Veteran Certifying Official
Email: cpacheco@jjay.cuny.edu
Phone: 212-237-8153
Fax: 212-237-8936
James Ifill – Financial Aid Adviser; Veteran Certifying
Email: jifill@jjay.cuny.edu
Phone: 212-237-8156
Fax: 212-237-8936
4. Please indicate your course(s) below: (attached a separate sheet if additional space is needed)
Course Name
Course Number
Course Section
Number of
Ex. Psychology
IV. Student Affirmation
Initial each line to indicate that you have read and understand your responsibilities for
______ I hereby request that the School Certifying Official (SCO) submit my enrollment
information, as indicated on this form, to the Department of Veterans Affairs (VA).
______ I understand that the SCO is responsible for notifying the VA promptly of any changes
I make to my enrollment and that I, John Jay College, or both, may become liable for
Tuition, fees and/or overpayments as a result of these changes.
______ I understand that I must notify the SCO immediately if I drop, withdraw or stop
attending classes as it may affect my enrollment certification.
______ I certify that the above listed class(es) are required for my program of study as listed
on Degree Audit at the time of signing this form.
______ I understand that I must be meeting satisfactory academic progress requirements toward
my program of study and that the SCO is responsible to promptly adjust or amend my
enrollment certification and report to the VA my lack of progress thereof.
______ I understand that if I utilize the VA’s one-time “Round Out” policy, I can only do so if I
am enrolled in my graduating semester, have applied for graduation, and I must complete
all required courses certified under this policy. (Note, students using VR&E must speak
with your VA Counselor).
______ I understand that if I amusing Chapter 30 or Chapter 1606 that I must report my
attendance to the VA each month online at: https://www.gibill.va.gov/wave/index.do
* Please contact the Certifying Official for specific questions related to your benefit(s) and
Student Signature __________________________________________ Date ____________