Enrollment Certification Form

In order to certify for classes each semester, including summer semesters and intersessions, please fill out the certification form below. Upon completion it will automatically be sent via email to the Veteran Services office and you will not need to visit the office in person to submit.

You will need to fill out the certification form every time you are enrolling for a new semester at UCA.

The University of Central Arkansas requires all students to certify their schedule with the Veteran Services Office every term in which they want to have their classes certified to the Department of Veterans Affairs for disbursement of VA Education Benefits. Please do not submit certification forms until you have your final schedule and all classes have been registered. If you are on a waitlist, submit your schedule, and if/when you have added and/or removed classes, submit the new schedule accordingly.

Enrollment Certification Form

Name*
First Middle Last
UCA Student ID Number*
Students Social Security Number*
VA Benefit Chapter Number*
VA File Number*
If you are using Chapter 35, this is the Sponsor's Social Security Number
Date of Birth*
Phone Number*
Degree type*
Example: BS, BA, BBA, Etc.
Major*
Minor*
Gender
We use this information for demographic tracking and to inform you of specific scholarships and benefits you may qualify for.
Are you changing your Major or Minor?*
Are you graduating this term?*
What is your Military Status?*
Branch of Service*
- Army
- Navy
- Airforce
- Marines
- Coast Guard
- I do not know
Please select all that apply. For Dependents, please select your parent(s) branch of service.
Duty Status*
If currently serving, remember to submit a letter of good standing from your unit to Student Accounts to receive a 25% tuition discount.
First time Attending College Anywhere*
First time using VA Benefits at UCA?*
Using FTA (Federal Tuition Assistance?)*
Note: If requesting FTA, you must submit at least 6 weeks prior to term.
Using NGTW (National Guard Tuition Waiver)?*
Note: If using National Guard Tuition Waiver, you must submit online through Camp Robinson Education Office. Please see the link on our web page.
Permanent Mailing Address*
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code
UCA Email*
Personal Email
Semester*
Year*
Ex. 2020
Credit Hours*
Please enter a value between 1 and 25.
List all transitional courses below

Ex: UNIV 0390 Transitional Courses are indicated on your schedule with UNIV as the course subject abbreviation.
Please list any courses you are repeating

Ex: MATH 1390 Students are not able to use benefits for courses already successfully completed. This includes courses taken before receiving VA benefits. If the student passes with a "D" or better, the VA will not certify a retake of the course unless the degree program requires a higher grade.
List any courses that you are using FTA for

EX: MATH 1390 Federal Tuition Assistance (FTA) Courses will be paid for using Federal Aid. This form of payment can only be utilized by current service members. FTA can be used in conjunction with Chapter 1606 for the same courses. If requesting FTA, you must submit at least 6 weeks prior to the start of the term to avoid needing an exception to policy.
Degree Plan
Students can only receive benefits for classes in their degree plan. Your degree audit from Degree Works will be pulled and added to your file, along with this form.
Certification*
Students must certify their classes each semester with the Veteran Resource Center. Students must ensure a copy of their Certificate of Eligibility is on file with the Veteran Resource Center, fill out the Enrollment Certification Form in person or on the Veteran Resource Center web page, and submit a class schedule with the Certification Form each semester.
Changes to your schedule*
Students must notify the certifying official of any changes in their schedule such as: classes being added or dropped, withdrawal from all classes, non-attendance, or leaving school because of military service obligations or extenuating circumstances.
Student Responsibility*
By submitting this form, you understand that it is the total responsibility of the student to provide correct information pertaining to; current enrollment, courses being dropped, added, or repeated, changes in degree program, repeated courses, transitional courses, change to mailing address, changes to phone number, and non-attendance. Failure to provide this information may result in a delay or loss of VA benefits, misdirected checks, and possible repayment to the VA.
Date*
Please attach a copy of your schedule*
Accepted file types: pdf, jpg.
Degree plan
Accepted file types: jpg, pdf.
If you haven't submitted already
Certificate of Eligibility (COE)
If you haven't submitted already