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You must complete this form online or visit the veterans information center to complete this form to request to have your enrollment certified. IF you do not request to have your enrollment certified you will not get paid or your payment may not be applied to your account.
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I,   (Full Name),   (Student Id), request to have my enrollment certified for   (# of hours i.e 6) hours for the Summer 2016 semester in the program of study of  . I will contact the Veterans Information Center if changes occur to my enrollment status for the term specified above. Below is a list of all the course(s) that I am registered for this semester. I acknowledge that these courses are in my degree plan.

Please list course(s) that you are registered for in this format: e.g. CIS 146 01. You must list at least one (1) course.


I certify that all information on this form is complete and accurate. I understand that withholding information requested or giving false information may result in my enrollment NOT being certified.

Student Signature: Email: Date: