Dixie State University :: Veterans :: Semester Certification Request

Semester Certification Request

This form must be used each semester to notify the Veterans Compliance Coordinator of the following options:

You have registered for classes and request VA certification
You are submitting courses that do not fall directly into your degree plan, but have evidence of pre-requisite for future classes
Notification of degree plan change also requires submission of the Major Change Form to Registration in addition to completing the form below.

Semester Certification Form

If you are human, leave this field blank.

Personal Information

First Name *

Middle Name

Last Name *

Maiden or Former Name

Phone Number *

Dixie ID

Dmail Address *

Semester

Semester you are requesting VA benefits for *

Are any of your classes repeat courses? *

Yes

Reason for repeating courses?

Are any of your classes online? *

Yes

Do any of your classes fall outside your degree plan but are pre-requisites for future courses? *

Yes

Please identify the pre-requisite course and the future course

Is this your graduating semester? *

Yes

Students may be receive a “round out” of credits up to 12 to remain full-time during their graduating semester and may take or retake any course needed to bring the semester credits to full-time. This option is only available one time.

Are you requesting the "round out" option?

Yes

Is this a change of Major from the last certification? *

Yes

Have you changed your Major with registration? *

Yes

Major changes must use the Major Change Form and submit to registration for processing.

Will you be receiving any scholarships or tuition waivers for this semester?

Yes

(This does not include FAFSA, VA or Military education benefits)

What Chapter of GI Bill will you be using?

Chapter 33 Post 9/11

Chapter 33 TOE (dependent transfer of entitlement)

Chapter 30 Montgomery GI Bill (Active Duty)

Chapter 31 Vocational Rehab

Chapter 35 Dependent Education Assistance (DEA)

Chapter 1606 Montgomery GI Bill (Reserve/National Guard)

FTA , STA or STW

OtherOther

I don’t know

(It is the student’s responsibility to submit copies of the FTA/STA/STW authorization documents to the DSU Veterans Success Center for processing)

Will you be receiving Pell grants or loans and will you need monies from these dispersed on the first week of school due to a financial hardship?

Yes

Please briefly describe your hardship. *

What degree are you seeking? *

Comments

By submitting this form, I acknowledge the following:

I am responsible for the payment of my tuition and fees regardless of VA benefits received.
The VA will not pay for more than 100% of tuition. If you are receiving a Tuition Waiver, Tuition specific scholarships, or any other aid specifically earmarked for Tuition, that corresponding amount will not be submitted for payment to the VA.
The only registered classes that can be certified are those that fall within my degree plan.
It is my responsibility to notify the Veterans Coordinator if I add or drop a class. (including block classes)
Classes can be purged for non-payment of tuition if I have an outstanding balance with Dixie State University
I am also giving permission to the DSU Veteran and Military Service staff to share personal information (i.e. grades, tuition, etc) with the following agencies: Department of Veteran Affairs (VA), Department of Defense (DOD) and the Utah Department of Military and
Veteran Affairs.

Acceptance *

I accept the above statement

Contact

Steve Roberts

Director of Veteran and Military Services

Semester Certification Request

Personal Information

Semester

(It is the student’s responsibility to submit copies of the FTA/STA/STW authorization documents to the DSU Veterans Success Center for processing)