Request for Certification Form (Online, City Park, Sidney Collier, Charity School of Nursing)

Note: This form is intended for students of online programs, the City Park Campus, the Charity School of Nursing, and the Sidney Collier Site. 

If you are a student at the West Bank Campus or the Jefferson Site, please submit the other request for certification form.

All Students
This is required for Ch. 35 users.
Major must be listed in LoLA.
Major must be listed in LoLA.
If you are a transfer student, you must complete VA Form 22-1995 or VA Form 22-5495. If you are a guest student, please provide a parent letter.
If yes, you must contact the bursar's office every semester to use this benefit.
If yes, you must present this certificate to the bursar's office every semester.
If yes, you must submit a Veteran/Service Member/Dependent/Spouse Non-Resident Tuition Waiver Request Form to have this adjusted.
Read each line carefully and provide your initials for each line. If the information doesn't apply to you, please enter "NA" for not applicable.
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Please initial. For questions about this, see a VA advisor.
Please initial.
Post 9/11 GI Bill Students
The following section pertains to Post 9/11 GI Bill students only. If this does not apply to you, please enter "NA" for not applicable.
Please initial.
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Please sign your full name.