Request For Veteran Enrollment Certification

Please carefully read each requirement for this document.

Name Name First Last
HPU ID (e.g. @12345678)
Term
Degree/Major
Phone Phone - ### - ### ####
HPU Email Address:
Address Address
Street Address Address Line 2 City State / Province / Region Postal / Zip Code Country
Check the VA Educational Benefit You Are Claiming

Check the VA Educational Benefit You Are Claiming Chapter 30 (Montgomery) Chapter 31 (Vocational Rehabilitation) Chapter 33 (Post 9/11) Chapter 35 (Survivor/Dependent DEA) Chapter 1606 (Reserve National Guard)
If known please disclose your remaining entitlement on your VA education benefit months and days
Check If Any Of The Following Apply

Check If Any Of The Following Apply Are you currently active duty? *Will you be separating this term? Is this your first enrollment for the chapter of VA benefits? (If so attach your COE or Statement of Benefits)) Have you changed schools (transferred) since your last certification? *Are you currently enrolled at another school? Are you recieving any Military TA, ROTC, or MYCAA funds this term? (Please attach)
Attach a PDF copy of your Certificate of Eligibility

Attach Files
*If you are separating from the service this term please list separation date* *If you are separating from the service this term please list separation date* / MM / DD YYYY
If concurrently, enrolled at another school, HPU is :
*If you are at another school please list the name of the institution*
Course Schedule, please list ONLY Registered Course(s) (ex BIOL 100), Credit(s), Required? (Yes or No), Repeat (Yes or No), and Campus or Online.
Academic Advising Location

Academic Advising Location Hickam Kaneohe Pearl Harbor Schofield Barracks Tripler Travis Butler College of Professional Studies Downtown College of Business Downtown College of Health and Society Downtown College of Liberal Arts Downtown College of Natural Computational Sciences Downtown
1. All of the above-listed courses are eligible for certification to the VA and are required for my degree program;
2. It is my responsibility to notify the HPU VA Coordinator of any changes to my registration (adds/drops), tuition or fees;
3. If I drop or fail a course, I may be required to repay the benefits that I have received (including housing) for the course; and
4. I am personally obligated to pay any debts to the University resulting from reductions or terminations of enrollment or Veteran benefit eligibility regardless of original method of payment.
5. Failing a class due to non-attendance, including not participating in online classes, will result in Last Day of Attendance being reported to the VA resulting in possible VA debt, including a repayment of housing payments.
6. I understand that if I am not eligible for VA benefits or do not have sufficient entitlement I am financially responsible for tuition to the University.
7. I understand that if I am suspended or dismissed from HPU due to unsatisfactory academic progress, it may result in my benefits getting suspended.

1. All of the above-listed courses are eligible for certification to the VA and are required for my degree program;
2. It is my responsibility to notify the HPU VA Coordinator of any changes to my registration (adds/drops), tuition or fees;
3. If I drop or fail a course, I may be required to repay the benefits that I have received (including housing) for the course; and
4. I am personally obligated to pay any debts to the University resulting from reductions or terminations of enrollment or Veteran benefit eligibility regardless of original method of payment.
5. Failing a class due to non-attendance, including not participating in online classes, will result in Last Day of Attendance being reported to the VA resulting in possible VA debt, including a repayment of housing payments.
6. I understand that if I am not eligible for VA benefits or do not have sufficient entitlement I am financially responsible for tuition to the University.
7. I understand that if I am suspended or dismissed from HPU due to unsatisfactory academic progress, it may result in my benefits getting suspended. By checking this box I agree to the above statements
Draw your signature into the box below.

Draw or Type

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Full Name

I understand this is a legal representation of my signature.