Students must submit this form every term to initiate VA Benefits
Request for Enrollment Verification Are you a new student? If yes, did you attend military orientation?
Office of Veteran & Military Student Affairs
Yes
No
Name:
Address:
Student ID:
Phone:
City:
State:
Zip Code:
Email :
Academic Major:
Term:
Yes
No
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@uccs.edu
Changed Major? Contact the OVMSA Office.
SSN: 1st Semester Only
(eg. Spring 2015)
Are You Receiving In-State Tuition Rates?
Yes
Spring 16
No
Are you currently Active Duty?
Applied
No
Yes
Status:
Undergraduate
Graduate
Are you expecting to graduate this semester?
Are you currently enrolled in another institution?
If yes, then where?
Yes
Yes
No
No
Which school is granting the degree?
(Note: If you are enrolled in another institution, please request a "Parent School Letter")
VA Education Benefit You are Using this Term *1606 and 1607 cannot be used with Federal Tuition Assistance
Chapter 33
(Post 9/11)
Chapter 1606*
(Reserve/Guard)
Chapter 30
(Montgomery GI Bill)
Chapter 1607*
(REAP)
Chapter 31
Chapter 35
(Voc Rehab)
(DEA)
Yellow Ribbon: ______________________
You must schedule an appointment to use Yellow Ribbon
Do you intend to use Ch 31 Voc Rehab benefits for the first time, during this term?
Please certify my enrollment :
Yes
No
ENTIRE ENROLLMENT
Only Specified Courses
Initial Here
(Contact a Student Employee for Assistance)
Student Responsibilities
Initials
I am requesting the UCCS Office of Veteran and Military Student Affairs (OVMSA) to certify my enrollment with the
VA for this term. Unless specified above, I request my entire enrollment for this term to be certified with the VA.
Once the Request for Enrollment Verification is submitted, I understand that it is my responsibility to notify the
OVMSA of any changes in my enrollment and/or program. Any change in primary program requires a "Change of
Program or Place of Training" form, before certification can be completed.
I acknowledge that resident rates and payments are my responsibility as well as knowledge of UCCS policies. This
includes, but is not limited to, residency waivers and the College Opportunity Fund (COF).
I understand changes in enrollment may result in a debt to the school and/or the VA. Any debts will be my
responsibility to resolve.
I understand that UCCS OVMSA can only certify enrollment with the VA for courses which meet my program/degree
requirements.
If I am an "unclassified" student, I understand that my enrollment can only be certified with the VA for two semesters.
Before my enrollment can be certified for the third semester, I must declare a VA approved program.
I acknowledge understanding of the above statements. All information provided is true and correct.
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SIGNATURE
DATE
Please note that your uccs.edu address is the official email communication for the VA and the Bursar's Office