VA Certification Request

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Please do not fill out this form until you have finished registering for your classes.

* is a required field.

* First Name:	M.
* Last Name:
* Student ID#, VO#:
* Degree Program :	(be specific)
* Phone:
* E-mail:
* Expected Graduation Date :
I wish to be certified for the following semester(s):
Fall Semester (Session I):	Semester Hours
Spring Semester (Session II):	Semester Hours
Summer Semester (Full Term):	Semester Hours
Summer Semester (Term A):	Semester Hours
Summer Semester (Term B):	Semester Hours
Comments: