Request for GI Bill ® Enrollment Certification

Fields marked with an asterisk (*) are required.

• Name *

  First Last
• IUPUI University ID# *
  Must be 10 digits. Currently entered: 0 digits.
• Which best describes your enrollment?*

  IUPUI IU McKinney School of Law IU School of Medicine (Graduate and professional level only) IUPUC IU Fort Wayne
• What is your residency classification on your campus?

  Resident/in-state student Nonresident/out-of state student
• Address *

  Street address Address line 2 City Select a State Alabama Alaska Arizona Arkansas California Colorado Connecticut Delaware District of Columbia Florida Georgia Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Hampshire New Jersey New Mexico New York North Carolina North Dakota Ohio Oklahoma Oregon Pennsylvania Rhode Island South Carolina South Dakota Tennessee Texas Utah Vermont Virginia Washington West Virginia Wisconsin Wyoming State/Province/Region Postal/Zip code United States Country
• Phone

  - Area Code - Prefix Line Number
• University email *

• Please indicate semester and year you wish to be certified for:

  **A separate form must be filled out for EACH SEMESTER**
  
  
  Courses offered for the Winter Term 2020 (between November 30, 2020 – February 7, 2021) are ALL online and will be reported to the VA as such. When listing below, use the following for the winter 2020 and spring 2021 terms
  
  Winter Term 2020: Coursework that begins November 30th, 2020
  Spring Term 2021: Any coursework that begins in January or February 2021

• Term *
• Year (YYYY) *
• Which VA Education Benefit Program would you like to be certified under this semester?*

  Chapter 30 Montgomery (Active Duty) GI Bill ® Chapter 31 Vocational Rehabilitation Chapter 35 Spouse/Dependent of Veteran Chapter 1606 Montgomery (Reserve/National Guard) GI Bill ® Chapter 33 Post 9/11 GI Bill ®
• Voc Rehab Counselor *

  First Last
• Chapter 35 file # *
  Maximum of 10 characters allowed. Currently entered: 0 characters.
• Ext # *
  Must be 2 digits. Currently entered: 0 digits.
• Eligibility percentage *
• Have you received this benefit from someone else’s service?*

  Yes No
• I understand that I am NOT allowed to use Federal Tuition Assistance when I use my GI Bill ® and by electing to complete this form and apply for FTA could put me in overpayment which would require me to return any funding received for my GI Bill ® back to the Department of Veterans Administration. * Please initial

  Please initial

  Maximum of 2 characters allowed. Currently entered: 0 characters.
• I understand that if I am receiving Chapter 1606 benefits, that I am required to verify my attendance on the last day of the month with the Department of Veterans Affairs online at www.gibill.va.gov/wave/ or by calling 877-823-2378. By verifying my attendance, this is telling the VA that I am attending my course(s) and have earned my funding. In addition, I understand that if I verify my attendance and stop attending course(s) I will be in overpayment with the VA and will be required to return any funding received by them. * Please initial

  Please initial

  Maximum of 2 characters allowed. Currently entered: 0 characters.
• I understand that typical full-time enrollment is 12 hours for undergraduate and 8 for graduate coursework. This may vary based on the length of the term. It is recommended to take 15 hours per semester to complete a 4 year undergraduate degree taking 2 semesters per year. * Please initial

  Please initial

  Maximum of 2 characters allowed. Currently entered: 0 characters.
• I understand that I must attend at least one on-campus course to receive the full BAH. I understand that I will receive only half the national rate if I attend all online courses. I understand that I have to be enrolled more than half time to receive any BAH. * Please initial

  Please initial

  Maximum of 2 characters allowed. Currently entered: 0 characters.
• Are you using Federal Tuition Assistance (FTA)?FOR CHAPTER 33

  Yes No
• Are you using Federal Tuition Assistance (FTA)?*

  Yes No
• I understand that the OVMP is required by law to discuss my Academic and GI Bill ® information with my VA Vocational Rehabilitation Counselor. * Please initial

  Please initial

  Maximum of 2 characters allowed. Currently entered: 0 characters.
• I am notifying the OVMP that I need to notify the OVMP if I am electing to use my FTA with my Montgomery (Active Duty) GI Bill ®. * Please initial

  Please initial

  Maximum of 2 characters allowed. Currently entered: 0 characters.
• By initialing this box, I am notifying the OVMP that if I am receiving Chapter 30 benefits, that I am required to verify my attendance on the last day of the month with the Department of Veterans Affairs online at www.gibill.va.gov/wave/ or by calling 877-823-2378. * Please initial

  Please initial

  Maximum of 2 characters allowed. Currently entered: 0 characters.
• During the last academic year I used my education benefits at...*

  IUPUI IUFW IUPUC I have never used my GI Bill ® benefits Other
• The place I have previously used my education benefits is... *

• Required review

  By initially each of the boxes I understand and acknowledge that I have reviewed, understand and will comply with expectations and requirements outlined below. In addition, I understand that these statement are there to assist me while I am using VA Education benefits at the University.

• You will need to complete the 22-1995 or 22-5495 (service member/dependents, respectively) if your benefits are coming from another school than listed above.

• I understand that OVMP employees are NOT VA Employees and are here for my benefit and will treat them in a professional and respectful manner. *

  I understand that OVMP employees are NOT VA Employees and are here for my benefit and will treat them in a professional and respectful manner.
• I understand that the OVMP staff are here for my benefit and will treat them in a professional and respectful manner *

  I understand that the OVMP staff are here for my benefit and will treat them in a professional and respectful manner
• I understand that it is my responsibility to complete an Enrollment Certification Form EACH semester I plan to use my Veteran Education Benefits after I enroll in classes. *

  I understand that it is my responsibility to complete an Enrollment Certification Form EACH semester I plan to use my Veteran Education Benefits after I enroll in classes.
• I understand that it takes approximately 30-45 days to start receiving VA benefit checks after I submit my enrollment certification or after the term begins, whichever is later. *

  I understand that it takes approximately 30-45 days to start receiving VA benefit checks after I submit my enrollment certification or after the term begins, whichever is later.
• I understand that if my semester has accelerated coursework or mini-terms (1, 2, 4, 6, 12 weeks), I may drop below full-time which may impact my monthly payments. *

  I understand that if my semester has accelerated coursework or mini-terms (1, 2, 4, 6, 12 weeks), I may drop below full-time which may impact my monthly payments.
• I understand that I will ONLY receive VA Education Benefits for courses meeting graduation requirements for my program of study. *

  I understand that I will ONLY receive VA Education Benefits for courses meeting graduation requirements for my program of study.
• I understand the VA will NOT pay for repeat courses where I receive a “D” or better (except where a higher grade is required for graduation). In addition, courses where I have received a grade of “I” (Incomplete) cannot be recertified for payment until the course is completed and I receive a final grade.

  I understand the VA will NOT pay for repeat courses where I receive a “D” or better (except where a higher grade is required for graduation). In addition, courses where I have received a grade of “I” (Incomplete) cannot be recertified for payment until the course is completed and I receive a final grade.
• I understand that I must notify the OVMP of any changes (adds/drops/withdrawals) that occur with my enrollment during the semester and that these changes may, or may not, affect my VA education benefits. *

  I understand that I must notify the OVMP of any changes (adds/drops/withdrawals) that occur with my enrollment during the semester and that these changes may, or may not, affect my VA education benefits.
• I understand that courses where I receive grades that signify non-attendance (to include, but not limited to “FN” (Failure due to Non-attendance), “W” (Withdrawal), and “F”, etc.) is required by law to be reported to the VA as a reduction in hours, specifying the last date that I attended the course(s). In addition I understand that this reduction in hours may lead to my having to REPAY some, or all, of my VA education benefits for the specified course(s) in question back to the VA. *

  I understand that courses where I receive grades that signify non-attendance (to include, but not limited to “FN” (Failure due to Non-attendance), “W” (Withdrawal), and “F”, etc.) is required by law to be reported to the VA as a reduction in hours, specifying the last date that I attended the course(s). In addition I understand that this reduction in hours may lead to my having to REPAY some, or all, of my VA education benefits for the specified course(s) in question back to the VA.
• I understand that the benefits I receive from the VA for my monthly stipend, or housing allowance (BAH), is paid per day that I am enrolled in a given semester. Therefore, I understand that each term has months that are paid on a prorated basis (i.e. the fall term begins near the end of August) and that the VA will not provide me any monthly stipend/BAH between terms (i.e. Fall term ends in December, Spring term begins mid-January, etc.). This includes accelerated terms that begin/end in the middle of a normal sixteen week term. *

  I understand that the benefits I receive from the VA for my monthly stipend, or housing allowance (BAH), is paid per day that I am enrolled in a given semester. Therefore, I understand that each term has months that are paid on a prorated basis (i.e. the fall term begins near the end of August) and that the VA will not provide me any monthly stipend/BAH between terms (i.e. Fall term ends in December, Spring term begins mid-January, etc.). This includes accelerated terms that begin/end in the middle of a normal sixteen week term.
• I understand that if I appeal for a grade change from “F” to “W” or “I” to “W” that this must be reported to the VA. I understand that although this may benefit me academically, there WILL be financial implications with VA and potentially with Financial Aid. *

  I understand that if I appeal for a grade change from “F” to “W” or “I” to “W” that this must be reported to the VA. I understand that although this may benefit me academically, there WILL be financial implications with VA and potentially with Financial Aid.
• Have you completed a Change of Training Form (22-1995 or 22-5495, service member/dependents, respectively) and submitted it to the VA?

  Yes No
• Do you have your Certificate of Eligibility?*

  Yes No
• Please attach your Certificate of Eligibility
  Attach Files

• Certificate of Eligibility

  Please remember to submit your Certificate of Eligibility to the Office for Veterans and Military Personnel when you receive it.

• What Degree are you working to complete? *
• Have you changed majors since your last VA enrollment certification? *

  Yes No
• Are you repeating any classes?*

  Yes No
• Which ones? *
• Do you expect to graduate this term?*

  Yes No
• Are you interested in receiving information from the student group Veterans@IUPUI and/or the OVMP Newsletter?*

  Yes No

• Required review

  By checking the boxes below I am acknowledging my understanding that I have reviewed, understand and will comply with the outlined expectations and requirements (as well as those that were listed on the form when I first enrolled). Any violation of this outline may result in the transfer of debt to me (the student) as I will be held liable for any and all monies paid to the school from the VA (In addition to having my BAH and/or stipends recouped). I hereby certify that all statements are true and complete to the best of my knowledge and belief.

• I request that ALL my enrolled coursework be certified for VA education benefits with the exception of those courses that are NOT required for my degree. *

  I request that ALL my enrolled coursework be certified for VA education benefits with the exception of those courses that are NOT required for my degree.
• I understand that if I fail a course due to non-attendance that my instructor(s) will be contacted for the date I last attended the course(s) AND that date will be reported to the VA as required by law. In addition, I understand that my lack of attendance in any course could result in a retroactive loss of benefits, sometimes back to the first day of class, unless the VA finds that mitigating circumstances were involved in the change. *

  I understand that if I fail a course due to non-attendance that my instructor(s) will be contacted for the date I last attended the course(s) AND that date will be reported to the VA as required by law. In addition, I understand that my lack of attendance in any course could result in a retroactive loss of benefits, sometimes back to the first day of class, unless the VA finds that mitigating circumstances were involved in the change.
• I understand that ANY changes to my class schedule (enrollment) may alter the payment I will receive by the VA. Therefore, it is imperative for me to notify the OVMP of any changes to my enrollment by emailing them at gibenefi@iupui.edu, fwmil@iufw.edu or military@iupui.edu. *

  I understand that ANY changes to my class schedule (enrollment) may alter the payment I will receive by the VA. Therefore, it is imperative for me to notify the OVMP of any changes to my enrollment by emailing them at gibenefi@iupui.edu, fwmil@iufw.edu or military@iupui.edu.
• I understand that I am liable for any overpayment I might receive from the VA and that I can file an appeal for mitigating circumstances with the VA by following the instructions on the overpayment letter that I will receive. *

  I understand that I am liable for any overpayment I might receive from the VA and that I can file an appeal for mitigating circumstances with the VA by following the instructions on the overpayment letter that I will receive.
• I understand that the OVMP is required to report grades changes to the VA, therefore, I understand appealing for a grade change from “F” to “W” or “I” to “W” (including any grade or withdraw being changed to a drop to the beginning of the term) WILL have financial implications with the VA and potentially with Financial Aid. *

  I understand that the OVMP is required to report grades changes to the VA, therefore, I understand appealing for a grade change from “F” to “W” or “I” to “W” (including any grade or withdraw being changed to a drop to the beginning of the term) WILL have financial implications with the VA and potentially with Financial Aid.
• I understand that I must complete this form each semester after registering for classes. *

  I understand that I must complete this form each semester after registering for classes.
• I understand that the OVMP is NOT allowed to speak with my parent/friend/spouse about my VA education benefits unless there is a signed Release of Information on file at the OVMP. This form MUST be completed in person. *

  I understand that the OVMP is NOT allowed to speak with my parent/friend/spouse about my VA education benefits unless there is a signed Release of Information on file at the OVMP. This form MUST be completed in person.
• Draw your signature into the box below. *
  Draw or Type

  I understand this is a legal representation of my signature.

  Clear

  Full Name

  

  I understand this is a legal representation of my signature.

  I understand this is a legal representation of my signature.

• Date *

  / MM / DD YYYY

• GI Bill® is a registered trademark of the U.S. Department of Veterans Affairs (VA). More information about education benefits offered by VA is available at the official U.S. government Web site at www.benefits.va.gov/gibill.