UD Veteran Benefits Enrollment Data Form

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First and Last Name:

UD ID Number:

Student Phone Number:

UD Email Address:

Email address must be of a valid format.

Student Physical Address:

Time of incident:

Specific location:

Student Information

Involved party 1

First and Last Name

UD ID Number

Student Phone Number

UD Email Address

Student Physical Address (street address, city, state, zip code)

Questions

What branch of the US Armed Forces did you serve in? If you are a dependent what branch did the veteran serve in?(Required)

Air Force Army Coast Guard Marines Navy Space Force Public Health Service National Oceanic and Atmospheric Administration

This field is required.

Which education benefits are you using?(Required)

Dependents Educational Assistance (CH.35) Post 9/11 GI Bill (CH.33) Vocational Rehabilitation (CH.31) Montgomery GI Bill - Active Duty (CH.30) Montgomery GI Bill Select Reserve (CH.1606) VA STEM Extension Army Tuition Assistance Air Force Tuition Assistance Navy Tuition Assistance Marines Tuition Assistance

This field is required.

Are you a veteran (or actively serving member of the military) or a dependent?(Required)

Veteran (or actively serving member of the military) Dependent

This field is required.

For which term are you requesting benefits ? (Choose One. Please submit an additional form for each additional term that you would like to use benefits.)(Required)

Fall 2023 Winter 2024 Spring 2024 Summer 2024 Fall2024 Other not listed here (Indicate which former semester for which you are seeking to use benefits in the notes below)

This field is required.

How many credit hours are you taking for the term? We can only certify you for what you show in the system now, even if you plan on enrolling in future courses. Please wait until you are enrolled in all planned courses before completing this form.(Required) This field is required.

Are you an undergraduate, graduate or continuing education student?(Required)

Undergraduate Graduate Continuing Education

This field is required.

Are you planning on keeping the Student Health Insurance charge on your account for this semester? If not, please begin the process to remove it at the below link: https://www.universityhealthplans.com/secure/waiver.cgi?group_id=278(Required) This field is required.

I certify that I have checked to make sure that the program I am attempting to use benefits for is a WEAMS approved program. If your program of study is not approved in WEAMS we will not be able to certify you for the term in question until the program is approved. https://inquiry.vba.va.gov/weamspub/buildSearchInstitutionCriteria.do(Required)

Yes No

This field is required.

If you have any comments or suggestions, please leave your remarks below. This field is required.

VA Certificate of Eligibility

If this is your first semester using VA benefits, please attach your VA certificate of eligibility. If you have already submitted this form in another term you do not need to resubmit. 5GB maximum total size.
Attachments require time to upload, so please be patient after submitting this form.

Student Information

Questions

VA Certificate of Eligibility

Submission