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Student Data Form - Military Benefits Information Form
Complete this form and click SUBMIT. It will be sent to the Office of the University Registrar.
It is your responsibility to notify the School Certifying Official/Office of the University Registrar of
changes in your enrollment, credit load, major and/or address.
Personal Information (Please complete ALL fields.)
Address Line 1
Address Line 2
Program of Study.
Anticipated graduation date (MM/YY).
Which of the following best describe your situation?
I am a continuing Duke student who attended the previous semester and utilized military benefits.
I am a continuing Duke student and I have never used military benefits. Note: a copy of the Certificate of Eligibility (COE) must first be submitted. The student will be apprised of additional documentation needed after the receipt of the COE.
I am a new Duke student and have not previously used any military benefits to pay for my education.
I am a new Duke student transferring from another school, and I have used benefits at my previous institution. Note: a copy of the 22-1995 or 22-5495, Change of Place of Training form must be submitted. Benefit certification cannot occur until that form is on file.
I am a former Duke student who has decided to return and use military benefits.
Select the term you are requesting certification for.
Summer II 2017
Summer I 2017
My classes begin on (MM/DD/YYY).
Credits/units anticipated for the term indicated above.
Total credits/units I will be registering for.
Of those credits/units, how many are in a classroom setting?
Of those credits/units, how many are in an online format?
Of those credits/units, how many are independent study/directed study/continuation?
Are all of the courses for which you are requesting certification required by your degree program?
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