Form CGAP-D

Benefits Certification Request

Form CGAP-D
All classes listed for benefits must be required in: University studies, major program, or general electives as prescribed in the University of Connecticut catalog. Classes must always reduce hours required to complete the degree goal. Courses taken in an audit status or other non-credit form cannot be certified. This form and any accompanying paperwork must be filled out and processed for each term for which payment of benefits are requested.
FORM CGAP-D
Name*
First Last
Student ID*
Choose appropriate program level*
CAUTION - STOP! Please contact The Veterans Affairs and Military Programs Office before you continue with this form.
You have selected Non-Degree as your Program Level. Please contact this office as the Veterans Tuition Waiver and the National Guard Tuition Waiver cannot be used for Non-Degree courses. GIBill benefits can be used in limited situations.
Is this the first time you are requesting benefits through this office?*
Did you pay an enrollment deposit this semester? This normally applies to new incoming freshman and transfer students only.*
Any changes to your contact information since your last Form D?*
Address*
Street Address Address Line 2 City State ZIP Code
Home Campus*
(The Campus you were admitted to and is listed as your home campus in Student Admin). You may be taking some classes at a different UConn Campus, but your MHA is based on where you physically take a majority of your credits. If you have changed campus (from a regional to Storrs or vice versa) please select the campus listed in Student Admin.
What academic term are you requesting?*
(ex. Spring 2024)
Are you the Veteran/Service Member or a dependent?*
Which GI Bill are you using, if any?*
Are you using a tuition waiver?*
Which GI Bill are you using?*
Please provide your Chapter 33 percentage*
Is the USCGA covering the payment for your tuition?
VA file number*
This is typically the service member's SSN
Payee Number*
LATE FEES - IMPORTANT INFO! IF YOU ARE USING A WAIVER (FULL OR PARTIAL) YOU MUST DO THE FOLLOWING TO AVOID LATE FEES!*
To avoid late fees you must: 1. Submit your form CGAP-D before your fee bill due date 2. Settle any balance that will remain after the application of the waiver (or will remain once the waiver is applied or the Coast Guard pays for your tuition) before the fee bill due date. If you need more information on the amount that will remain after the application of the waiver, please contact this office. You must settle this amount before the fee bill due date regardless of the application or status of your waiver. PLEASE CONTACT THIS OFFICE IF YOU NEED CLARIFICATION ON THE AMOUNT YOU MAY BE RESPONSIBLE FOR. DO NOT WAIT FOR YOUR WAIVER TO BE APPLIED PRIOR TO PAYING THE AMOUNT YOU MAY BE RESPONSIBLE FOR.
- Acknowledged
Health Insurance*
Please be sure to waive the UConn Health Insurance. The USCGA will not cover this charge, and the student will be responsible.
I verify that I am registered for the following number of credits:*
Please only submit the Form D when you have finished enrolling in ALL of your courses.
Military Affiliation - Veterans/Guard/Reserve/Active Duty*
Please select your current/last Military Affiliation
Military Affiliation - Dependents*
Please choose the Military Affiliation of the sponsor who transferred benefits to you.
Residency Status - Are you considered OUT OF STATE for tuition purposes?*
Email
Comments
Please post any additional comments or information that you may have.
Acknowledgment and Submission
I acknowledge that I am responsible for all of the following and that I: -will inform the Veterans Benefits Office of any changes in course load -file a Form D with the Veterans Benefits every semester I want to use my benefits. -understand that academic dismissal may terminate my benefits. -----understand that I am liable for overpayments made by the VA, including overpayment due to enrollment changes on my behalf. --acknowledge that if found ineligible by the VA I am solely responsible for tuition, fees, and any other charges. -work with an academic advisor to ensure that all courses are completed satisfactorily for my degree program. -report my attendance at the end of every month directly to the VA if using Chapters 1606, 1607, or 30 -notify the Veterans Benefits Office and the Registrar if I withdraw from the University due to a deployment or hardship. -regularly review my degree requirements with an approved academic advisor -understand that I will be certified and paid based on the information provided on this form and the amount of benefits I have remaining. -- -understand that if there are any modifications to this forms format, or if I have failed to completely fill out this form it can be considered invalid and I will be required to resubmit for my benefits using an official Form D -understand that administrative actions can be taken against me if I have claimed any false information on this Form D. -understand that Form D submissions will be processed in the order that they are received, which can result in delayed processing and payment if I have failed to submit this form on time.
File Upload - optional
Optional Field: You can upload your COE, NOBE, or other documents. If you have forms that you wish to send us, you can use this feature to do so. No forms are "required" to be sent in with your form D.
Drop files here or

Accepted file types: jpg, gif, png, pdf, Max. file size: 250 MB, Max. files: 5.
Email
This field is for validation purposes and should be left unchanged.

Form CGAP-D

Benefits Certification Request

Form CGAP-D
All classes listed for benefits must be required in: University studies, major program, or general electives as prescribed in the University of Connecticut catalog. Classes must always reduce hours required to complete the degree goal. Courses taken in an audit status or other non-credit form cannot be certified. This form and any accompanying paperwork must be filled out and processed for each term for which payment of benefits are requested.
FORM CGAP-D
Name*
First Last
Student ID*
Choose appropriate program level*
CAUTION – STOP! Please contact The Veterans Affairs and Military Programs Office before you continue with this form.
You have selected Non-Degree as your Program Level. Please contact this office as the Veterans Tuition Waiver and the National Guard Tuition Waiver cannot be used for Non-Degree courses. GIBill benefits can be used in limited situations.
Is this the first time you are requesting benefits through this office?*
Did you pay an enrollment deposit this semester? This normally applies to new incoming freshman and transfer students only.*
Any changes to your contact information since your last Form D?*
Address*
Street Address Address Line 2 City State ZIP Code
Home Campus*
(The Campus you were admitted to and is listed as your home campus in Student Admin). You may be taking some classes at a different UConn Campus, but your MHA is based on where you physically take a majority of your credits. If you have changed campus (from a regional to Storrs or vice versa) please select the campus listed in Student Admin.
What academic term are you requesting?*
(ex. Spring 2024)
Are you the Veteran/Service Member or a dependent?*
Which GI Bill are you using, if any?*
Are you using a tuition waiver?*
Which GI Bill are you using?*
Please provide your Chapter 33 percentage*
Is the USCGA covering the payment for your tuition?
VA file number*
This is typically the service member’s SSN
Payee Number*
LATE FEES – IMPORTANT INFO! IF YOU ARE USING A WAIVER (FULL OR PARTIAL) YOU MUST DO THE FOLLOWING TO AVOID LATE FEES!*
To avoid late fees you must: 1. Submit your form CGAP-D before your fee bill due date 2. Settle any balance that will remain after the application of the waiver (or will remain once the waiver is applied or the Coast Guard pays for your tuition) before the fee bill due date. If you need more information on the amount that will remain after the application of the waiver, please contact this office. You must settle this amount before the fee bill due date regardless of the application or status of your waiver. PLEASE CONTACT THIS OFFICE IF YOU NEED CLARIFICATION ON THE AMOUNT YOU MAY BE RESPONSIBLE FOR. DO NOT WAIT FOR YOUR WAIVER TO BE APPLIED PRIOR TO PAYING THE AMOUNT YOU MAY BE RESPONSIBLE FOR.
- Acknowledged
Health Insurance*
Please be sure to waive the UConn Health Insurance. The USCGA will not cover this charge, and the student will be responsible.
I verify that I am registered for the following number of credits:*
Please only submit the Form D when you have finished enrolling in ALL of your courses.
Military Affiliation – Veterans/Guard/Reserve/Active Duty*
Please select your current/last Military Affiliation
Military Affiliation – Dependents*
Please choose the Military Affiliation of the sponsor who transferred benefits to you.
Residency Status – Are you considered OUT OF STATE for tuition purposes?*
Email
Comments
Please post any additional comments or information that you may have.
Acknowledgment and Submission
I acknowledge that I am responsible for all of the following and that I: -will inform the Veterans Benefits Office of any changes in course load -file a Form D with the Veterans Benefits every semester I want to use my benefits. -understand that academic dismissal may terminate my benefits. —–understand that I am liable for overpayments made by the VA, including overpayment due to enrollment changes on my behalf. –acknowledge that if found ineligible by the VA I am solely responsible for tuition, fees, and any other charges. -work with an academic advisor to ensure that all courses are completed satisfactorily for my degree program. -report my attendance at the end of every month directly to the VA if using Chapters 1606, 1607, or 30 -notify the Veterans Benefits Office and the Registrar if I withdraw from the University due to a deployment or hardship. -regularly review my degree requirements with an approved academic advisor -understand that I will be certified and paid based on the information provided on this form and the amount of benefits I have remaining. — -understand that if there are any modifications to this forms format, or if I have failed to completely fill out this form it can be considered invalid and I will be required to resubmit for my benefits using an official Form D -understand that administrative actions can be taken against me if I have claimed any false information on this Form D. -understand that Form D submissions will be processed in the order that they are received, which can result in delayed processing and payment if I have failed to submit this form on time.
File Upload – optional
Optional Field: You can upload your COE, NOBE, or other documents. If you have forms that you wish to send us, you can use this feature to do so. No forms are “required” to be sent in with your form D.
Drop files here or

Accepted file types: jpg, gif, png, pdf, Max. file size: 250 MB, Max. files: 5.
Email
This field is for validation purposes and should be left unchanged.

Form CGAP-D

Form CGAP-D

FORM CGAP-D

Acknowledgment and Submission

Form CGAP-D

Form CGAP-D

FORM CGAP-D

Acknowledgment and Submission