Office of the Registrar
Georgetown University Law Center
McDonough Hall, Room 315
600 New Jersey Avenue, NW
Washington, DC 20001
Phone: 202-662-9220 Fax: 202-662-9235
E-mail: lawreg@law.georgetown.edu
VETERANS’ ENROLLMENT CERTIFICATION FORM – LAW CENTER
The Office of the Registrar must receive the following from each student who requests a veteran’s enrollment certification:
(1) A copy of the Certificate of Eligibility from the US Department of Veterans Affairs (VA). This form is provided by
the VA after a student has applied for educational benefits using the Veterans’ Administration Application for
Benefits Form (VONAPP). The application is available online at http://www.gibill.va.gov.
(2) A Veterans’ Enrollment Certification Form (this form) each semester
☐Indicate here if you have not previously used your veterans’ educational benefits at the law center
☐Indicate here if you are a recent transfer student or have changed your program of study since last semester
☐Indicate here if this is an update to a form that you have submitted earlier this semester/term
Semester/Year ______________________________ GoCard Number:_____________________________________________
Name: Last:_____________________________ First:________________________ Middle:________________ Suffix: _____
D.O.B.:____________________________
Has your address
changed since you
applied for veterans’
benefits?
☐Yes
☐No
Mailing Address: __________________________________________________________________
___________________________________________________________________
__________________________________________________________________
Telephone Number: ______________________________________ (Day) __________________________________ (Evening)
Georgetown E-mail:_____________________________________ Alternate E-mail: _________________________________
Program of Study:
☐JD ☐LLM ☐Other _________________________________________________(program name)
Length of Study:
Start Date:___________________(month/year) Expected Completion Date:____________________
Status Type (Check one): ☐Veteran
☐Child of Veteran/Active Duty Member
☐Spouse of Veteran/Active Duty Member
☐ Active Duty: If active duty, will you receive military Tuition Assistance, other than VA benefits this semester? ☐Yes
☐No
Benefit Category (Check one):
☐CH 33 – Post 9/11 GI Bill: Percentage of Eligibility: _________________________________________ (see Certificate of Eligibility)
☐CH 30 – Montgomery GI Bill
☐CH 31 – Vocational Rehabilitation: Name of Case Manager: ______________________________________________________
☐CH 35 – Survivors’ and Dependents’ Educational Assistance Program (DEA)
☐CH 1606 – Montgomery GI Bill – Selected Reserve
☐CH 1607 – Reserve Educational Assistance Program (REAP)
☐Other: ______________________________________________________________________________________________________________
Benefit Length: Please indicate the number of months of eligibility remaining for your benefit chapter: _____________________________
Registration Status: Enrolled Credits for the Semester: ____________Tuition:___________________ Fees: ________________
***Form continues on the back***
Please list the courses that you are registered for this semester/term
Course #
Title
Credits
Does this course meet for the entire semester?
If not, please provide the course dates.
__________
__________________________________
_____
☐Yes
☐No
Dates:_______________________
__________
__________________________________
_____
☐Yes
☐No
Dates:_______________________
__________
__________________________________
_____
☐Yes
☐No
Dates:_______________________
__________
__________________________________
_____
☐Yes
☐No
Dates:_______________________
__________
__________________________________
_____
☐Yes
☐No
Dates:_______________________
__________
__________________________________
_____
☐Yes
☐No
Dates:_______________________
☐Indicate here if you are repeating any classes that you have taken before in a prior semester/term or at another institution
☐Indicate here if any of your classes are taught online only and please provide the course title: _______________________________
Please read the following acknowledgement and sign this form.
Veterans’ educational benefits are administered by the US Department of Veterans Affairs (“VA”). The Office of the Registrar uses the
information provided and other information from your student record in order to verify your enrollment for purposes with the VA. This is
required for processing and your submission of this form serves as authorization for the release of this information. Educational
verifications processed by the Office of the Registrar do not entitle students to Yellow Ribbon Program benefits. Those benefits must be
separately requested via the Yellow Ribbon Program at the Law Center. In addition, for certification purposes, courses taken must be
required for your degree and satisfactory progress is expected. Withdrawing from courses, after enrollment has been certified to the VA
may reduce payment eligibility. Generally, overpayments of VA benefits are the responsibility of the student. Generally, courses taken
without credit, audited, or not attended may be ineligible for certification. Furthermore, courses that meet for less than a full fall or spring
semester may qualify for benefits payment at a rate less than those lasting for a full semester, this includes summer courses. Questions
regarding benefits eligibility and payment must be directed to the VA at 1-888-GI-Bill-1.
Student Signature (Required)_____________________________________________________ Date: __________________________
☐Indicate here if you would like e-mail confirmation to acknowledge receipt of this form