2022-23 VA Benefits Certification Request
Please complete the following form in full to ensure that your Department of Veteran Affairs Educational Benefits are submitted for certification. Expect to receive an email within two weeks confirming that your request has been certified to the VA.

**THIS FORM MUST BE COMPLETED EACH SEMESTER YOU WISH TO RECEIVE VA BENEFITS**
**PLEASE WAIT TO SUBMIT UNTIL YOUR SCHEDULE IS FINAL**
** ANY CHANGES TO ENROLLMENT STATUS MUST BE COMMUNICATED BY SENDING AN EMAIL TO VETSERVICES@UDAYTON.EDU **
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Email *
Student ID Number (It is located on your student ID) *
Last Name *
First Name *
Benefit Chapter (Check only one) *
Which term are you requesting benefits for? *
Number of Enrolled Credit Hours *
What is your military affiliation? *
Are you receiving any tuition-only awards? (e.g. Graduate Assistant positions, Online scholarship, UD Promise, Tuition Remission, National Guard scholarship, Ohio War Orphan & Severely Disabled scholarship , and Federal Tuition Assistance) *
What is your program level? *
What is your major? *
DO NOT FORGET!
**THIS FORM MUST BE COMPLETED EACH SEMESTER YOU WISH TO RECEIVE VA BENEFITS**
**PLEASE WAIT TO SUBMIT UNTIL YOUR SCHEDULE IS FINAL**
** ANY CHANGES TO ENROLLMENT STATUS MUST BE COMMUNICATED TO VETSERVICES@UDAYTON.EDU **
A copy of your responses will be emailed to the address you provided.
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