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Veterans Certification Request

Name *

First

Last

Address *

Street Address

Street Address Line 2 / APO

City

State / Province / Region / Military Base

Postal / Zip Code

Country

Student ID Number *

Phone Number *

###

####

Drury Email Address *

Branch of service *

Army

Navy

Air Force

Marines

Coast Guard

Dependent

Status *

Veteran/Retired

Dependent

Active Duty

Guard

Reserve

I am a: *

Continuing Drury Student

First Time Drury Student

Semester: *

Fall

Spring

Summer

Winter (Dec- Jan)

Academic Year (Aug- Aug) 2020-21

Other Year

Current degree/certificate program *

Change to degree/program *

Yes

No

I am a guest student and my parent school is:

Guest school contact

I request to have my enrollment certified to the VA for the following benefit: *

Ch 30 (Montgomery G.I. Bill - Active Duty)

Ch 31 (Disabled Veterans/Vocational Rehabilitation)

Ch 33 (Post 9/11 GI Bill)

Ch 35 (Survivors/and Dependents Education Assistance Program)

Ch 1606 (Montgomery G.I. Bill - Reserve/National Gurad)

Please provide VA Case Manager Email

I UNDERSTAND I MUST SUBMIT A VERTERAN CERTIFICATION REQUEST FORM EVERY SEMESTER I ATTEND DRURY UNIVERSITY*

I AUTHORIZE DRURY UNIVERSITY TO RELEASE MY TRANSCRIPTS TO THE VA AS REQUIRED*

I UNDERSTAND THAT IF I SUBMIT MY VETERANS CERTIFICATION REQUEST MORE THAN 30 DAYS AFTER THE BEGINNING OF THE SEMESTER, IT WILL BE REPORTED TO THE VA ON MY VA CERTIFICATION REQUEST*

I UNDERSTAND THAT IF I DO NOT HAVE THE 100% PAYMENT RATE ON THE POST 9/11 GI BILL, I AM RESPONSIBLE FOR THE BALANCE*

I UNDERSTAND I MUST REPORT ANY SCHEDULE CHANGES TO THE VETERANS BENEFITS COORDINATOR IMMEDIATLEY - BJUNGEN@DRURY.EDU*

IF I AM PLANNING ON USING FEDERAL OR STATE TUITION ASSISTANCE ALONG WITH THE GI BILL, I MUST CONTACT BJUNGEN@DRURY.EDU.*

IF USING CH30, CH33 OR CH1606, I WILL VERIFY ATTENDANCE WITH THE VA AT 1-877-823-2378 OR www.gibill.va.gov/wave.

I HAVE PROVIDED ACCURATE INFORMATION, HAVE READ AND UNDERSTOOD THE GI BILL GUIDELINES AND FAQ LINKS AND AGREE TO COMPLY WITH ALL VA REGULATIONS.

Your Full Name *

Today's Date *

MM

DD

YYYY

Information you think the school certifying official needs to know:

CONTACT

Phone. 417.873.7879

Email. drury@drury.edu

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