Certification Request for VA Benefits - Athens State University

Name(Required)

Semester(Required)

Address(Required)

Street Address City State ZIP Code

Athens State Email(Required)

You must use your Athens State email address.

Athens State ID Number(Required)

Phone(Required)

VA Benefit Chapter(Required)

Chapter 33 (Post 9/11)

Chapter 31(Vocational Rehabilitation)

Chapter 30 (Montgomery GI Bill)

Chapter 1606 (Select Reserve)

Chapter 35 (Dependent)

If Chapter 35, VA File #

Please list other scholarships or tuition assistance that you receive.(Required)

Declared Major(Required)

Major Type(Required)

BFA

MA/MS

List the Classes that apply toward your degree here CRN/Subject/Credit Hours. (Only Courses That Apply Toward Your Major Can Be Certified)(Required)

Is Athens State University your parent institution?(Required)

Yes

If no, please give us the name of your parent institution

Do you have a transient letter on file in the Athens State VA Office and the Records Office from your parent institution?(Required)

Yes

I certify that all information contained herein is complete and correct. I understand that completion of this form assures me of enrollment certification with the Department of Veterans Affairs. I understand that continued eligibility for VA educational benefits relies upon my meeting satisfactory academic progress.

I understand that I am required to notify the School Certifying official of any schedule changes.

Student Name(Required)

Athens State Email

Date(Required)