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Veteran Registration and Certification Form
The completion of this form authorizes Veteran Services to provide required information and to certify your enrollment at MSSU for a specified semester to the U.S. Department of Veteran Affairs, St. Louis, Mo.
First Name:
Middle Initial:
Last Name:
SSN:
Address:
City:
State:
Alabama
Alaska
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
District of Columbia
Florida
Georgia
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
Missouri
Montana
Nebraska
Nevada
New Hampshire
New Jersey
New Mexico
New York
North Carolina
North Dakota
Ohio
Oklahoma
Oregon
Pennsylvania
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
Vermont
Virginia
Washington
West Virginia
Wisconsin
Wyoming
Zip Code:
Phone Number:
Is this a change of address?
Yes
No
Email Address:
Branch of Service:
Military Affiliation/Statues
Active Duty
Veteran
Reservist
National Guard
Spouse
Dependent
Please check all that apply:
CH 30 Montgomery G.I. Bill-Prior or Active Duty
CH 31 Disabled Veteran/Vocational Rehabilitation
CH33 Montgomery GI Bill (Post 9/11 Transfer of Entitlement)
CH 33 Montgomery GI Bill (Post 9/11)
CH 35 Survivors/Dependents Education
Veteran's SSN
CH 1606 Montgomery G.I. Bill Selected Reserve National Guard
CH 1607 Reserve Educational Assistance Program
Are you currently National Guard, Active Duty or Reserves
Yes
Have you applied for financial aid?
Yes
No
Please Select Type of Degree:
Bachelor
Associate
Master
Other
What is your major(Major must be declared by end of second semester)?
None
Accounting (BSBA)
Accounting Accelerated (BSBA)
Advanced EMT
Advanced EMT
American Studies (C)
App Development (C)
App Development (C)
Applied Behavior Analy (C)
Applied Behavior Analy (C)
Applied Data Analytics (MBA)
Art-Visual (BA)
Artificial Intelligence(GCert)
Autism Spectrum Disorder(C)
Automation (Cert)
Automation (Cert)
Bachelor of Applied Sci (BAS)
Bachelor of Applied Sci (BAS)
Bachelor of Gen Studies (BGS)
Bachelor of Gen Studies (BGS)
Behavioral Neuroscience (C)
Biochemistry EmphasisMKEAP(BS)
Biology-Biotech Micro Gen (BS)
Biology-Ecol Marine Cons (BS)
Biology-Gen Bio or Und (BS)
Biology-PhysOccup Thpy (BS)
Biomed Sci PreDental (BS)
Biomed Sci PreMed MKEAP (BS)
Biomed Sci PreMed/PA (BS)
Biomed Sci PreOptom (BS)
Biomed Sci PrePharm (BS)
Biomed Sci PreVet (BS)
Biomed Sci Undeclared (BS)
Business Administ -NWMSU (MBA)
Business Analytics (GCert)
Business Pathway (Meta Major)
CADD Operator (Certif)
CIS CrimJustAdm-Comp Foren(BS)
CIS Math-ComputationalMath(BS)
CIS-Info Systems (AS)
CIS-Info Tech(BS) w/CPI (Cert)
CIS-Info Technology (BS)
Campaigns & Elections(C)
Chem-Biochemistry(BS)
Chem-Forensic Science(BS)
Chem-Predental(BS)
Chem-Premedical(BS)
Chem-Preoptometry(BS)
Chem-Prepharmacy(BS)
Chem-Preveterinarian(BS)
Chem::Health Professional(BS)
Chemistry (BA)
Chemistry (BS)
Chemistry Lab Science (Cert)
Clinical and Counseling Psy(C)
Coaching
Communication-Mass (BA)
Communication-Public Rela (BA)
Communication-Public Rela (BS)
Communications-Mass (BS)
Community Health (C)
Conservation Management (CERT)
Continuous Process Impro(Cert)
Continuous Process Impro(Cert)
Corrections (Cert)
Costume Technology(Cert)
Creative Writing (C)
CrimJustAd CIS-Comp Foren (BS)
Crime Scene Investigations (C)
Criminal Investigation (Cert)
Criminal Justice Adm (BS)
Criminal Law (Certificate)
Cultural Anthropology (CERT)
DO NOT USE - MAcc-accelerated
Data Analytics (MS)
Dental Hygiene (AS)
Dental Hygiene Applicnt (AS)
Developmental Psychology(C)
Digital Crse Design Del(GCert)
Digital Marketing Comm(C)
EHS-Env. Protection (CERT)
EHS-Env. Protection (CERT)
EHS-General Emphasis (CERT)
EHS-General Emphasis (CERT)
EHS-Occupt'l Hlth&Sfty (CERT)
EHS-Occupt'l Hlth&Sfty (CERT)
EHS-Public Health (CERT)
EHS-Public Health (CERT)
ERROR -Hlth Prom Well (AS)
Economics (BS)
Economics (BSBA)
Education (MBA)
Education-Art {K-12}(BSE)
Education-German {K-12} (BSE)I
Education-Instrumental (BME)
Education-Phys Ed {K-12} (BSE)
Education-Spanish K-12(BSE)
Education-Vocal (BME)
El Ed (1-6)&Sp Ed {K-12} (BSE)
Ele Ed&Erly Ch {Birth-3} (BSE)
Elec Studies Outside Field(BM)
Elem Ed 1-6 & ELL {K-12} (BSE)
Elem Ed-Foregin Language(BSE)
Elementary Education (BSE)
Emergency Med Tech (Certif)
Emergency Med Tech (Certif)
English-Lit Studies (BA)
English-Lit Studies (BS)
English-Prof Tech Writ (BA)
English-Prof Tech Writ (BS)
Entrepreneurship (BSBA)
Envin Health & Safety (BAS)
Envin Health & Safety-DL (BAS)
Environmental Hlth &Safety(BS)
Environmental Hlth &Safety(BS)
European Studies (C)
Exercise Science (BS)
Exploratory (Degree Seeking)
Finance (BSBA)
Fine Arts-Design (BFA)
Fine Arts-Studio (BFA)
Fire Fighter (Certif)
Fire Fighter (Certif)
Food Science & Nutrition (BS)
GR Provisional-Art
GR Provisional-Business
GR Provisional-Educ
GR Provisional-Music
Gen Studies Business Emph(BGS)
Gender Studies (Cert)
General (Historical Data)
General Business (BSBA)
Geography (BA)
Geography (BS)
German (BA) (I)
Global Black Studies (C)
Global Citizenship (Cert)
Global Cultural Studies (BA)
Grad Stud in Sociology(GCert)
Grad Studies History(GCert)
Hazardous Mat Mgt (C)
Hazardous Mat Mgt (C)
Health Science-DentalHyg (BS)
Health Science-Paramedic (BS)
Health Science-RadTech (BS)
Health Science-ResTher (BS)
Healthcare Admin (MBA)
Healthcare Administration (BS)
Healthcare Business (Cert)
History (BA)
History (BS)
Homeland Security (C)
Honors Intdsicp Studies (c)
Human Resource Mgmt (MBA)
Human ResourceManagement(BSBA)
IPA-General Track (BS)
IPA-Social Science Educ (BS)
Illustration (Cert)
Industrial Engineer Tech (BS)
InformAssurance & Security (C)
Instrumental Performance (BM)
Integrated Mrkt/PubRelComm (C)
Interd. Photography (CERT)
Intern'tl Politics&Diplomacy(C
International Affairs (BA)
International Affairs (BS)
International Studies (BA)
Jazz Studies (Cert)
Justice Studies (MSJS)
Juvenile Justice (Cert)
Keyboard Performance (BM)
Language Studies-ELS NonDegree
Latin American Studies (Cert)
Law Enforcement-Opt A (AS)
Law Enforcement-Opt B (AS)
Legal Studies (C)
Linguistics (Certificate)
ML-Spanish (BA)
MS - Healthcare Administration
MS in Dental Hyg-UMKC (MS)
MS in Nursing (MSN) Coop
MSE Eng LL K-12 Certification
MSE Special Education
MSEd - Administration
MSEd Curriculum & Instruction
Management (BSBA)
Management (MBA)
Manufacturing Engin Tech (AS)
Marketing (BSBA)
Master of Arts in Teaching
Master of Arts in Teaching App
Masters_Non Degree Seeking
Math CIS-ComputationalMath(BS)
Mathematics (BS)
Mathematics Tutor I (Cert)
Mathematics Tutor II (Cert)
Medical Lab Science Appl (BS)
Medical Laboratory Science(BS)
Mid Sch-Language Arts(BSE)
Mid Sch-Math (BSE)
Mid Sch-Science (BSE)
Mid Sch-Social Studies (BSE)
Minor Awarded
Music (BA)
Music Industry (BS)
Music-Applied Pedagogy (GCert)
Music-Conducting (Cert)
Music-Ensemble Pedagogy(Gcert)
Music-Ensemble Perf (Cert)
Music-Industry (Cert)
Music-Instruction(Cert)
Music-Musical Theater (C)
Musical Theater (BM)
Musical Theater Perf (BFA)
New Media
No Major
Nursing (BS)
Nursing Applicant (BS)
Nutrition (C)
Nutrition (C)
Paralegal Studies Certi (I)
Paramedic (Certif)
Paramedic (Certif)
Peace Officer Train (Certif)
Physics Tutor I (Cert)
Physics Tutor II (Cert)
Pit Orchestra Perf. (CERT)
Policing (Certificate
Political Affairs (BA)
Political Affiars (BS)
Political Comm (Cert)
Political Science (BA)
Political Science (BS)
Post Bac Studies in Art(GCert)
Professional Comm (Cert)
Professional Writing (CERT)
Psychology (BA)
Psychology (BS)
Public Admin&Urban Planning(C)
Public History (Cert)
Publication Design (C)
RN to BSN Completion Appli (BS
RN to BSN Completion Prog (BS)
Radiologic Tech Applicant (AS)
Radiologic Technol (AS)
Rehabilitation Science (Cert)
Resp Thpy Applicant (AS)
Respiratory Therapy (AS)
Sec Ed Soc Sci Option 1 (BSE)
Sec Ed Soc Sci Option 2 (BSE)
Sec Ed-Chemistry (BSE)
Sec Ed-Ind Tech {9-12} (BSE)I
Sec Ed-Speech_Theater (BSE)
Secondary Ed-Biology 9-12(BSE)
Secondary Ed-Bus 9-12 (BSE)
Secondary Ed-Eng 9-12 (BSE)
Secondary Ed-Math 9-12 (BSE)
Six Sigma Black Belt (Certif)
Six Sigma Black Belt (Certif)
Six Sigma Green Belt (Certif)
Six Sigma Green Belt (Certif)
Social Institutions
Social Sciences (BS)
Social Work (BSW)
Social Work Applicant (BSW)
Sociology (BA)
Sociology (BS)
Spanish (Certificate)
Spanish for Professions (Cert)
Special Post-Grad
Sport & Rec. Management (MS)
Sport&Rec Mgmt Kinesiology(BS)
Stakeholder Engagement (C)
Supply Chain Management (BSBA)
Supply Chain Management (Cert)
TH Arts Admin&Leadership(C)
Teacher Leadership (GC)
Teaching Engl as Foreign Lang
Teaching Engl as Foreign Lang
The Center for Law andPolitics
Theater Directing (Cert)
Theater Performance (BFA)
Theatre (BA)
Theatre Industry (BS)
Theatre Industry (Cert)
Theatre Instruction (Cert)
Unmanned Aircraft (Cert)
Unmanned Aircraft (Cert)
Vocal Performance (BM)
Website Admin (C)
Website Admin (C)
Is this a change in Program?
Yes
No
Are you changing place of training?
Yes
No
Please Select One:
New Applicant
Continuing Student
Transfer Student
Please Select a Semester:
Fall
Spring
Summer
Intercession
Have you received VA benefits at other schools?
Yes
No
Have you requested transcripts from the other schools to be sent to MSSU?
Yes
No
List other colleges/universities attended :
I understand that:
I will provide a copy of my DD-214 and VA Certificate of Eligibility Letter to the School Certifying Official.
I will be enrolled in an approved program of study and ensure that all classes are in my degree plan.
I will attend class, make satisfactory progress, and maintain a 2.0 grade point average.
I will report any changes in my enrollment (add, drop or withdrawal) to the School Certifying Official.
I will provide information to the Financial Aid Office regarding my military status, category and monthly rate of pay.
I will provide my authorization for State or Federal Tuition Assistance to the School Certifying Official and Bursar Office.
I will be responsible for all tuition and fees, or the portion, not paid by my VA education benefits.
I will complete this form and sign prior to every semester I wish to use my VA education benefits.
By signing this form I authorize MSSU to certify my enrollment to the U.S. Department of Veteran Affairs
Please Sign with Your Username and Password:
Username
Password
3950 Newman Road
Joplin, MO 64801-1595
(417) 781-6778
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