ALL STUDENTS utilizing Veterans Educational benefits MUST complete this form each semester AFTER registering for classes. You should register as soon as possible and complete this certification request.

• I am eligible to receive VA Educational Benefits and request courses applicable to my degree be certified. • I am not repeating any courses previously taken and completed except as permitted by VA regulation. • I will notify the UTSA Veteran Certification Office of any changes to my enrollment, address, status or major. • Certifications for active duty or students below half-time cannot be sent to the VARO until the first day of classes. • I assume full responsibility for reimbursement of funds to UTSA or the VA should an over-payment occur as a result of this certification. • Chapter 31 --NOTE** If you are requesting certification within two weeks of the payment deadline or after (for any semester)

you must make payment arrangements (tuition loan or financial aid) until your enrollment is certified. Also, you must make sure your bill has been cleared (check your ASAP account) or your classes may be dropped. You must also comply with the book/supply voucher restrictions.

• Chapter 33 --NOTE** If you are requesting certification within two weeks of the payment deadline (for any semester) or after, you must make payment arrangements (tuition loan or financial aid) until the VA pays your tuition.

• ALL Chapters --NOTE** After initial certification for the semester requested has been done, any changes to your schedule will be processed after the census date.

Last Name:MI:First Name:

Street Address: Apt #:

City: State: Zip:

Major (Degree or Program): Minor:

Phone Number 1: Phone Number 2:

DateSignature*: (please type in full name)*Electronic signature - by signing and submitting this form electronically you are requesting certification for the terms selected.

With a few exceptions, you are entitled on your request to be informed about the information U.T. San Antonio collects about you. Under Sections 552.021 and 552.023 of the Texas Government Code, you are entitled to receive and review this information. Under Section 559.004 of the Texas Government Code, you are entitled to have U.T. San Antonio correct information about you that is held by us and that is incorrect, in accordance with the procedures set forth in the University of Texas System Business Procedures Memorandum 32.

I CERTIFY I have read and understand my responsibilities and agree to comply with the above.Remarks:

Preferred Email Address:

Are you working on a: Bachelors Degree Graduate Degree (Master's or PhD) Certificate Program (Paralegal or CFP)

Which Chapter are you? (check one)

31- Vocational Rehabilitation

35- Dependent30- GI Bill 1606- Reserves 1607- REAP33- Post 9/11

Yes No

Fall Spring Summer

Are you on active duty? NoYes Will your benefit expire during the term? Yes No

Are you graduating this semester? Yes No

- Do you have DV/Purple Heart plates?

Are you repeating a course for which you already have received credit? NoYes

Are you on tuition specific scholarships or using TA? (Note: If yes, any tuition specific funding must be deducted from your tuition and fees for the semester.)

Yes No

Answer the following questions for the semester you are certifying for:

Yes NoAre you using the Hazelwood Act?

If so, how much are you receiving? (Note: Enter 0 if you answered "No")

Note: Please see our website concerning repeated course information.

Course Name:

* Disclosure of your social security number (SSN) is requested from you in order for The University of Texas at San Antonio to access your student records. No statute or other authority requires that you disclose your SSN for that purpose. Failure to provide your SSN, however, may result in a delay in accessing your student record. Further disclosure of your SSN is governed by the Public Information Act (Chapter 552 of the Texas Government Code) and other applicable law.

Veteran Certification Office One UTSA Circle, San Antonio, TX 78249-0608 210-458-4540 | vacertification@utsa.edu | http://utsa.edu/va/

myUTSA ID:

CERTIFICATION REQUEST