OFFICE OF VETERAN & MILITARY STUDENT AFFAIRS

COURSE LOAD WORKSHEET

NAME: ADDRESS: CITY: STATE: ZIP CODE: SEMESTER REGISTERING FOR: STUDENT STATUS: Summer Yes Fall No Yes No Spring Junior Senior Grad Unclass Undergrad Unclass Grad Freshman Sophmore STUDENT ID: HOME PHONE: WORK PHONE: EMAIL (UCCS preferred): ACADEMIC MAJOR:

ARE YOU CURRENTLY ACTIVE DUTY:

ARE YOU RECEIVING, OR PLAN ON ASKING FOR, FEDERAL TUITION ASSISTANCE FOR THIS TERM? (NOTE: This is in addition to VA Benefits and includes: Active Duty TA, Reserve TA, or MyCAA funds) No Yes ARE YOU CONCURRENTLY ENROLLED AT ANOTHER INSTITUTION? IF YES, WHERE: SCHOOL GRANTING DEGREE VA EDUCATION BENEFIT YOU ARE/WILL BE RECEIVING: CH 33 (POST 9/11) CH 30 (GI BILL) CH 31 (VOC REHAB) CH 35 (DEA) CH 1606 (RESERVE/GUARD) CH 1607 (REAP) OTHER__________________

CERTIFY ENTIRE UCCS ENROLLMENT FOR THIS TERM, OR SPECIFY COURSES TO CERTIFY FOR THIS TERM? Yes, Entire Enrollment OR No, only those specified Specified Courses CLASS (MATH, ENGL, COURSE NUM etc)

Note: If entire enrollment is selected, there is no need to complete the specified courses table to the right It is the responsibility of the student to immediately notify this Office of ANY changes to course schedule. This includes: Adds, Drops, or (if applicable) Total Withdraw.

SEM HRs

PLEASE READ AND SIGN BELOW I am requesting the UCCS Office of Veteran and Military Student Affairs (OVMSA) to certify my enrollment with the VA for this term. Unless specified above, I request my entire enrollment for this term to be certified with the VA. If I elect to have the UCCS OVMSA to certify anything other than my entire enrollment, I will specify above, those courses I wish certified with the VA. Once Course Load Worksheet is submitted, I understand that it is my responsibility to notify the OVMSA, Main Hall RM 106, (719)255-3253, of any change in my enrollment and/or program (major). This includes adds, drops, and/or changes of major. Additionally, I understand changes in enrollment may result in overpayment, and/or reduced payment from the VA. I also understand any reduced payment, and/or debts created against me by the VA is/are my responsibility to resolve directly with the VA. I understand UCCS OVMSA can only certify enrollment with the VA for courses which meet my program/degree requirements. If enrolled in a course not specifically required by degree plan and I want the course(s) certified with the VA, I will provide a letter from my college advisor stating the course(s) will apply to my degree plan. If I am an "Unclassified" student, I understand that my enrollment can only be certified with the VA for two semesters as an "Unclassified" student. Before my enrollment can be certified for the third semester, I must matriculate (apply for, and be accepted into a VA approved program). Completed forms can either be faxed, e-mailed, or brought to our office. Fax: (719)255-3108 E-mail address: military@uccs.edu Office Location: Main Hall, Room 106 (M-F; 8am-5pm); Phone/Voice: (719)255-3253 SIGNATURE DATE