University of the Virgin Islands | #2 John Brewer Bay | St. Thomas, Virgin Islands 00802 |
Phone: (340) 693-1166 Fax: (340) 693-1167
University of the Virgin Islands | RR1 Box 10,000, Kingshill | St. Croix, Virgin Islands 00850-9781|
Phone (340) 692-4104 ● Fax (340) 692-4115
UVI-VeteranCertificationRequest rev3/28/2019
UVI-VETERANS REQUEST FOR CERTIFICATION
NAME: ________________________________________________________________________________ SIGNATURE: _________________________________
STUDENT ID#: ______________________________SOCIAL SECURITY: _____________________ DATE OF BIRTH: ______________________________
EMAIL: _______________________________________________________________________________________________________________________________
CELL PHONE: _____________________________________________________________ HOME PHONE: _________________________________________
MAILING ADDRESS: __________________________________________________________________________________________________________________
Is this your new address? YES or NO Select a Semester: Fall Spring Summer I Summer II
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 30 Montgomery GI Bill® Chapter 1606 Selected Reserve/National Guard
Chapter 31 Vocational Rehabilitation Chapter 1607 Reserve Education Assistance Program (REAP
Chapter 33 Post 9/11 GI Bill® Chapter 35 Survivor’s and Dependents’ Assistance
Are you planning to use Military Tuition Assistance? Federal YES or NO State 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 the University of the Virgin Islands, 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 are eligible for certification.
________ I understand that I must make satisfactory progress toward my educational goal and that the school
will report changed in my enrollment status, lack of academic progress, and any other information requested to the VA.
OFFICE USE ONLY:
Process by: ___________________________ Date:_____________________________
FALL 20___________
SPRING 20_________
SUMMER I 20_________
Regular Credits
Remedial/Skills
Video Credits/Online
Total Credits
TUITION
$
$
FEES
$
$
TUITION & FEES
TOTAL
$
$
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