Registrar's Office - Veteran Certification Request

Student Name *

First Name Last Name

E-mail *

Phone Number *

Area Code Phone Number

Address *

Street Address
Street Address Line 2
City	State / Province
Postal / Zip Code	Country

Date of Birth *

Student Division *

Semester *

Fall Spring Summer

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 1607 Vocational 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 University School of Law or the VA should my enrollment change in any way.

Student Signature *

Clear

Today's Date *

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