Registrar's Office - Veteran Certification Request

Veteran Certification Request
Student Name*

First NameLast Name
E-mail*
example@example.com
Phone Number*
Please enter a valid phone number
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry
Date of Birth*
Student Division*
Semester*

FallSpringSummer
Year*
VA Education Benefit

Dependents Educational Assistance (Chapter 35)Montgomery GI BILL Active Duty (Chapter 30)Montgomery GI BILL Reserve (Chapter 1606)Post 9/11 GI BILL (Chapter 33)REAP Chapter 1607Vocational Rehab (Chapter 31)VRAP (Must be full time)Yellow Ribbon
Specify %*
CHANGES IN ENROLLEMENT WILL AFFECT YOUR BENEFITS

I understand that it is my responsibility to:
- Complete a certification request for each semester I plan to receive VA benefits.
- Provide a Certificate of Eligibility or Notice of Basic Eligibility.
- Notify the Certifying Official of any changes to my enrollment or address.
- Assume full responsibility for any debt owed to Duquesne Kline School of Law or the VA should my enrollment change in any way.
Student Signature*

Clear
Today's Date*

MonthDayYear
Should be Empty: