UNT Dallas Veteran Enrollment Certification Form

To request certification, please complete this form. If you have any questions, please email va@untdallas.edu or visit the Veterans Success Center on the second floor of Founders Hall (FH).

Please allow 7-10 business days for your certification to be submitted.

Please fill out this form COMPLETELY to avoid delays in payment!

example: 12345678
List the last school where VA education benefits were used.
(i.e. semester and year; ex. Fall 2023)
Have you completed the 22-1995 (Request for Change of Program or Place of Training) OR 22-5495 (Dependent's Request for Change of Program or Place of Training)?
Are you using Hazlewood?
For which semester are you submitting this form?
List number of hours.
List each course (ex. ENGL1902 Freshman English).
Please read each item and select the option, which serves as your initial on this form, and states that you understand each statement and your level of responsibility for each.
I understand.
I Understand that I must complete this form, the VA Enrollment Certification Form EACH SEMESTER AFTER I register. *
Post 9/11 students: I will submit a copy of my VA Award letter or Education Enrollment Status (eBenefits) in order to certify my enrollment and receive my benefits each semester. *
I understand ONLY courses required on my degree plan will be certified for VA education benefits. *
I will inform the Certifying Official of ANY AND ALL CHANGES that I make to my schedule. *
I understand Veterans Affairs (VA) will hold me responsible for any overpayment of my education benefits as a result of dropping courses, non-attendance, withdrawing from UNTD, etc. *
I am responsible for paying any remaining balances on my account or risk being dropped from my classes. I am responsible for checking https://my.untdallas.edu for remaining account balances for tuition and fees that are not covered by my VA education benefits. (Ex: application fee, orientation fee, late registration fee, parking permit, parking tickets, out of state tuition/fees, excess hours charges, repeat course fees.) *
I understand that benefit payments are always paid one month in arrears and initial payment of benefits may sometimes be delayed at the Regional VA Processing Office due to workload. *
I authorize the release of all academic records and information by UNTD to the Veterans Administration. *
I certify that I am enrolled in courses for each semester/term listed above and the information is true and correct. *
This section serves as your digital signature. Please type your first and last name in the space below.