Cert Form Page 1
College of DuPage Veterans Services
Student Service Center (SSC), Room 2225
630) 942-3814 Fax (630) 942-4991
veterans@cod.edu
Veteran and Military Educational Benefit Certification Request Form
This form must be completed each semester, after registration for classes. A copy of your Certificate of Eligibility must be
on file with our office in order to process your certification request. Once you have turned in all necessary documents, we
will process your file within 10-15 business days.
1. Name _____________________________________________
Last, First, Middle
COD Student ID# __________________________
2. Which degree or certificate program are you seeking at College of DuPage? This entry will serve as an official change
of program. Please choose from Program Code List:
http://www.cod.edu/registration/records/forms/program_code_listing.aspx ________________________________
3. Are you seeking more than one degree or certificate program?
Yes
No
a. Indicate the 2nd program here. Both programs must lead to a singular career goal. ________________________
b. What is your career goal? ____________________________________________________________________
4. Please indicate the educational benefits you wish to use this semester.
Federal VA Benefits
___Chapter 33 – Post 9/11 GI Bill
Other Benefits
___Military Tuition Assistance, Branch_____________________
___Chapter 30 – Montgomery GI Bill
___ROTC, Branch____________________________________
___Chapter 31 – Vocational Rehabilitation
___MyCAA
___Chapter 1606 – Selected Reserve GI Bill
___Chapter 35 – Dependent Ed. Assistance
State Benefits
___Illinois Veterans Grant
___Illinois National Guard Grant
___MIA/POW Dependent Scholarship
5. Complete the information below for each course you wish to be certified for educational benefits. Please note that all
courses must be applicable to the degree or certificate program you listed above. Courses that are not applicable
cannot be certified for benefits.
TERM: ☐
Course Name
CRSNM
Fall 20___
Course
Number
XXXX
☐ Spring 20 ___
☐ Summer 20___
Section
Credit Hours
Course Start
Number
Date
XXX
3
XX/XX/2016
Course End
Date
XX/XX/2016
Which Benefit
to certify for
course?
Chapter XX
Cert Form Page 2
6. I have read and understand the terms and conditions in order to maintain eligibility for educational benefits.

I will submit a Veterans Certification Request form upon registering for classes each semester.

I will submit an Enrollment Change Request form if I make any changes to my schedule or academic program.

I will submit my military transcripts and official transcripts from all previously attended colleges and universities no
later than the end of my 1st semester at College of DuPage. I understand that failing to do so may result in my 2nd
semester courses not being certified for educational benefits.


I understand that the VA will not pay for the following:
o
Any course that is not required for completion of my degree or certificate program.
o
Any course for which I have attempted twice.
o
Any course for which I have received a passing grade, unless a higher grade is required.
o
Any course numbered below 1000 that is an online or distance education course.
o
Any course for which I do not attend or withdraw from.
I understand that grades of F, W and Incomplete (I) will be reported to the VA along with my last date of attendance,
which may result in a debt to the VA for books, housing, or tuition.

I understand that I must meet the Veteran Standards of Academic Progress by maintaining minimum academic
progress as determined by College of DuPage in accordance with State of Illinois, Department of Veterans Affairs,
and/or Department of Defense regulations. Failure to do so may result in the loss of eligibility for certification and I will
not be able to receive educational benefits until I meet said standards.

I understand that enrolling in courses that are less than the full semester length, or online/distance education courses
may reduce the amount of my federal educational benefits.

I understand that I am responsible for all debts to the VA and/or the College of DuPage which may include but are not
limited to overpayment, reductions or terminations of my enrollment.

I understand that College of DuPage will complete my request for certification within 10-15 business days and that the
VA processing time is 4-6 weeks after certification.
___________________________________________________________
Student Signature
________________________________
Date