School Certification for Veteran Students

First Name *

Middle Name

Last Name *

Student ID# *

Address *

City *

State *

Zip Code *

Daytime Phone *

Email *

Date of Birth *

Month

Day

Year

Program *

Number of credits enrolled per term *

Period of Enrollment *

Fall

Spring

Summer

Are you taking classes at the Grand Forks Air Force Base? *

Yes

No

Are you currently active duty military? *

Yes

No

Are you using VA Benefits as a: *

Veteran

Spouse of a Veteran

Child/Dependent of a Veteran

Service member's military branch *

Are you using military Tuition Assistance in addition to the GI Bill®? *

Yes

No

If yes, list type:

VA Chapter: *

Are you attending another institution now? *

Yes

No

If yes, list the institution:

Have you used VA Benefits at another institution? *

Yes

No

If yes, have you filed VA Form 22-1995?

Yes

No

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