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Veterans Request for Enrollment Certification Form
The amount of your monthly VA payments is determined by the number of hours for which you are enrolled during a semester. Therefore, this information must be accurate and current. Any change in your hours or registration FOR ANY REASON must be reported to the Ball State Veteran's Affairs Office (Lucina Hall, room 236) immediately. You are legally responsible for any over-payments made to you by the VA. Any falsification of information on this form is subject to review by the University Board of Review.

Items with an * indicate a required field.
Veteran's Information
First Name *
Middle Name *
Last Name *
Ball State ID # *
E-mail address
 
Enrollment Information
Semester for which you are requesting certification *
What program will be receiving education benefits? *
Is this your FIRST semester receiving VA benefits at Ball State? *  Yes
  No
If No, when did you last attend Ball State using VA benefits?  
Are you a service person on ACTIVE DUTY? *  Yes
  No
If you served on active duty, when did you enter?  
Current Degree Objective and Major *
Estimated Graduation Date *  
Number of undergraduate credit hours enrolled *
Number of graduate credit hours enrolled *
Are you enrolled in any repeat class(es)? *  Yes
  No
If Yes, please list class(es) being repeated
 
Mailing Address for CHECKS (complete only if not enrolled in Direct Deposit)
Street
City
State
Zip
Telephone
Is the address you are providing a change of address?  Yes
  No
 
Local Address (if different than mailing address)
Street
City
State
Zip
Telephone