Nicole Warner, School Certifying Official
Norwich University Veteran Affairs ● Hassett House
Phone: (802) 485-2355 ● Fax: (802) 485-2996
NU-VeteranCertificationRequest rev: 10/29/2019
REQUEST FOR CERTIFICATION OF VA EDUCATION BENEFITS
NAME: ________________________________________________________________________________ ID# _________________________________
NUMBER OF CREDITS ENROLLED IN: ____________________
MAILING ADDRESS: __________________________________________________________________________________________________________________
Is this a change of address? □ YES or □ NO
Year: _______ Select a Semester: ☐ Fall ☐ Spring ☐ Special
☐ Summer: __I __II __III
Degree: ☐ Associate’s ☐ Bachelor’s ☐ Master’s (Please indicate Major/Program currently pursuing)
Major/Program: _______________________________________ Is this the same major you had last term □ YES or □ NO
Are you currently serving in the military? □ YES or □ NO if yes, are you: □ Active Duty or □ Guard/Reserve
Please select GI Bill® Benefits program: Please submit Certificate of Eligibility for your respective GI Bill®.
☐ Chapter 31 – Vocational Rehabilitation (V)
☐ Chapter 33 – Post 9/11 GI Bill® (P)
☐ Chapter 33 Yellow Ribbon – Post 9/11 GI Bill® (Y)
☐ Chapter 1606 – Selected Reserve/National Guard (R)
☐ Chapter 35 – Survivor’s and Dependents’ Assistance (S)
☐ Do Not Certify - Do not wish to use my benefits this term (N)
Are you planning to use Military Tuition Assistance? Federal □ YES or □ NO
INITIAL EACH LINE TO INDICATE THAT YOU READ & UNDERSTAND YOUR RESPONSIBILITIES
_________ I must complete a new Veterans Request for Certification form EACH term that I wish to use GI Bill® Benefits.
_________ I understand that ANY registration changes, enrolling in an unauthorized repeat, or enrolling in a course not required to fulfill
my stated educational objectives may change my eligibility for GI Bill® Education benefits and might create a debt with either
Norwich Universtiy, the Department of Veterans Affairs, or both.
_________ I MUST notify the certifying official if I add, drop, withdraw or otherwise stop attending any of my classes.
_________ I understand that ONLY courses that apply toward my declared major (Undeclared - ONLY GenEd Requirments apply) are
eligible for certification.
_________ I understand that I must make satisfactory progress toward my educational goal and that the school will report changes in my
enrollment status, lack of academic progress, and any other information requested to the VA.
By signing I certify that I have read and understand the responsibilities initialed above: __________________________________ Date:____________
TUITION & FEES
TOTAL
OFFICE USE ONLY:
Initial Cert Date: ____________________________ Update (after add/drop):____________________
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signature
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