Revised 5/9/16
ALABAMA STATE UNIVERSITY
OFFICE OF VETERANS AND MILITARY AFFAIRS
VA ENROLLMENT CERTIFICATION FORM
Note: A form must be completed for each term of enrollment that you wish to be certified to the VA
Name: ______________________________________________ Local Telephone Number: ( ) -
SID#___________________ VA File # _____________________ SSN: __________________ DOB:_________
Email Address: ______________________________ Alternate Email Address: ____________________________
Permanent Address: ___________________________________ City/State: _____________ Zip Code: ________
Classification: □FRESH □SOPH □JUNIOR □SENIOR □GRAD Expected Graduation Date: _________
Current Major: _________________________________________________________________________________
I plan to use my VA benefits in the following semester: □Fall □Spring □Summer ________(indicate year)
I have used VA benefits before? □ Yes □No Service member, indicate Branch of Service: ________________
Check type of benefit:
□ Chapter 30 Montgomery G.I. Bill
□ Chapter 33 Post/911
□ Chapter 1606 Selected Reserves Montgomery G.I. Bill SR
□ Chapter 1607 Reserve Education Assistance Program (REAP)
□ Chapter 31 Voc. Rehab – Please provide:
Voc. Rehab Counselor Name: _______________________________________________
Voc. Rehab Counselor Email: ________________________________________________
□ Chapter 35 Dependent Education Assistance: Payee #___________________________________
Are you a Transient Student (taking courses here to apply towards a degree at another college? □Yes □No
If yes, what is the name of the school? _________________________________________________________
(Transient Students must provide written authorization from their parent school to enroll in specific courses before benefits can be processed)
STUDENT CERTIFICATION
I understand I can only be certified for courses listed on my program of study.
I understand I cannot be certified for courses for which I have already received credit.
I will promptly report changes to my schedule to the Certifying Officer such as DROPS, WITHDRAWLS, and ADDING COURSES.
Student Signature: ______________________________________________________________ Date: _________________
For Office Use Only
Transcript Received: □ Updated Degree Completion Plan Received: □ GPA: ______ Academic Status: □Good □Probation □Suspension □Dismissal
Last Academic Advisement: ________ Academic Status Letter to Student: ________ Academic Status Sent to VA ________ Referred to Advisement: _________
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