UNIVERSITY OF WEST FLORIDA
Veterans Services Office

Enrollment Certification

Semester:

NOTE:  VA students enrolling for their first semester must visit the Veterans Services Office to establish a file prior to requesting an Enrollment Certification.

Fill-out this form and then use the print command of your browser to print the form and either mail or FAX it to:
               University of West Florida
               Veterans Service Office
               11000 University Parkway Building 18
               Pensacola, Florida 32514
               Phone: (850) 474-2262     FAX: (850) 473-7345


First Name 
Middle Initial
Last Name
        
Social Security Number:


Street Address
City
State
Zip Code

Is this an address change? Yes   No

Home Phone: ( )      Work Phone: ( )

E-mail (optional):

Type of Training:  

Name of Program (degree):

Select benefit type:       Are you on active duty? Yes   No

List institution if you are dual enrolled:

Are these classes on your PDS? Yes   No

Transient student from:

Total Transient Hours:

Do you desire break pay? Yes   No
(Break pay counts against total entitlement benefits.)

Do you desire tuition deferment? Yes   No
(Tuition deferment can only be used one time per academic year.)

Is this your last semester at UWF? Yes   No

List all courses for which you are enrolled and indicate whether or not you want to be certified for each course by typing "yes" or "no" in the "Remarks" column.
Ref
Number		 Course
Number		 Credit
Hrs		 Term
(A,B,C,E)		 Course Title Tuition Remarks

Notice
  1. I understand that VA will only pay for courses that are part of my degree program, and that I must immediately report any changes to this course schedule to the UWF Veterans Services Office.
  2. I understand that I must apply for tuition deferment during the first week of classes and renew it prior to its expiration date or I will be responsible for late fees.  I understand that it is my responsibility to turn the deferment into the Cashier's Office prior to the end of drop/add week.

________________________________________
Student Signature and Date

For Veterans Service Office Use Only
Curent PDS on file:       All courses checked against the PDS: 

Verified and Processed on VACERT by:  _______________________________   _______________

                                                                    VSO Signature                                     Date
UWF Home            VSO Home
March 2001