USVI Public Records

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University of the Virgin Islands | #2 John Brewer Bay | St. Thomas, Virgin Islands 00802 | Phone: (340) 693-1166 ● Fax: (340) 693-1167 University of the Virgin Islands | RR1 Box 10,000, Kingshill | St. Croix, Virgin Islands 00850-9781| Phone (340) 692-4104 ● Fax (340) 692-4115 UVI-VeteranCertificationRequest rev3/28/2019 UVI-VETERANS REQUEST FOR CERTIFICATION NAME: ________________________________________________________________________________ SIGNATURE: _________________________________ STUDENT ID#: ______________________________SOCIAL SECURITY: _____________________ DATE OF BIRTH: ______________________________ EMAIL: _______________________________________________________________________________________________________________________________ CELL PHONE: _____________________________________________________________ HOME PHONE: _________________________________________ MAILING ADDRESS: __________________________________________________________________________________________________________________ Is this your new address? □ YES or □ NO Select a Semester: ☐ Fall ☐ Spring ☐ Summer I ☐ Summer II Degree: ☐ Associate’s ☐ Bachelor’s ☐ Master’s (Please indicate Major/Program currently pursuing) Major/Program: _______________________________________ Is this the same major you had last term □ YES or □ NO Are you currently serving in the military? □ YES or □ NO if yes, are you: □ Active Duty or □ Guard/Reserve Please select GI Bill® Benefits program: Please submit Certificate of Eligibility for your respective GI Bill®. ☐ Chapter 30 – Montgomery GI Bill® ☐ Chapter 1606 – Selected Reserve/National Guard ☐ Chapter 31 – Vocational Rehabilitation ☐ Chapter 1607 – Reserve Education Assistance Program (REAP ☐ Chapter 33 – Post 9/11 GI Bill® ☐ Chapter 35 – Survivor’s and Dependents’ Assistance Are you planning to use Military Tuition Assistance? Federal □ YES or □ NO State □ YES or □ NO INITIAL EACH LINE TO INDICATE THAT YOU READ & UNDERSTAND YOUR RESPONSIBILITIES ________ I must complete a new Veterans Request for Certification form EACH term that I wish to use GI Bill® Benefits. ________ I understand that ANY registration changes, enrolling in an unauthorized repeat, or enrolling in a course not required to fulfill my stated educational objectives may change my eligibility for GI Bill® Education benefits and might create a debt with either the University of the Virgin Islands, the Department of Veterans Affairs, or both. ________ I MUST notify the certifying official if I add, drop, withdraw or otherwise stop attending any of my classes. ________ I understand that ONLY courses that apply toward my declared major are eligible for certification. ________ I understand that I must make satisfactory progress toward my educational goal and that the school will report changed in my enrollment status, lack of academic progress, and any other information requested to the VA. OFFICE USE ONLY: Process by: ___________________________ Date:_____________________________ FALL 20___________ SPRING 20_________ SUMMER I 20_________ SUMMER II 20_________ Regular Credits Remedial/Skills Video Credits/Online Total Credits TUITION $ $ $ FEES $ $ $ TUITION & FEES TOTAL $ $ $ SIGN