Students Must Submit this Form Every Term to Initiate VA Benefits
Request for Enrollment Verification
Are you a new student?
Office of Veteran & Military Student Affairs
Yes
Name:
Address:
City:
State:
Zip Code:
If yes, did you attend military orientation?
No
Yes
Student ID:
Phone:
Email:
No
@uccs.edu
If you have recently changed your major, please contact
the OVMSA
Student SSN: (1st Semester Only)
Term: (eg. Spring 2015)
Are You Receiving In-State Tuition Rates?
Yes
No
Currently Active Duty?
Yes
Recently Applied
No
For Active Duty Only: Are you requesting Top Up?
Status:
Undergraduate
Graduate
Are you expecting to graduate this semester?
Are You Currently Enrolled In Another Institution?
If Yes, Where:
Yes
Yes
No
No
Which school is granting your degree?
(Note: If you are enrolled in another institution, please request a "Parent School Letter")
Select your VA Education Benefit
Chapter 30 (Montgomery GI Bill)
Chapter 33 (Post 9/11)
Yellow Ribbon
*You must schedule an appointment to use Yellow Ribbon
Chapter 35 (DEA)
Chapter 1606* (Reserve/Guard)
Sponsor's SSN (1st Semester Only)
Chapter 31(Voc Rehab)
Please select one option:
*1606 cannot be used with Federal Tuition Assistance
Did you recently apply to use Voc Rehab, for this term?
Yes
No
Certify my Entire Enrollment
Only Certify Specific 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.
SIGNATURE
DATE
*Please note that your uccs.edu address is the official email communication for the VA and the Bursar's Office