Certification Request Form

Certification Request Form

OFFICE OF VETERAN AFFAIRS
Name

First NameLast Name
Student ID Number
Current Program of Study
Ex: Health Care Assistant
Semester
Concentration
Ex: Certified Nurse Assistant
Level
Post 9/11:
Percentage (%) :
VA Educational Benefit Used:
Chapter 35 ONLY

Complete sponsor name and sponsors SSN
Sponsor Name

First NameLast Name
Sponsor SSN
STATEMENT OF UNDERSTANDING:
- a. I understand that if I make changes to my schedule, after my schedule is ready to be certified, those changes may result in overpayments or delays in funding. This can be, but not limited to, changing programs, adding classes, dropping classes, or withdrawing completely from a program.
- b. I understand that dropping or withdrawing from a class or even withdrawing completely may result in VA choosing to withhold funds from the school or request that funds be returned to VA. Either case may result in a debt owed to the school which I am fully responsible to repay.
- c. I understand that these overpayments may cause a debt to be created by the Department of Veteran Affairs and that it will be my responsibility to repay this debt.
- d. I understand that if I only qualify for a percentage of the VA benefits, or if I am considered out-of-state, that I am responsible for paying any tuition and fees that are not covered by the VA.
- e. I understand that when using my Chapter 30 (MGIB), Chapter 35 (Dependent/Spouse), or Chapter 1606 (Reserve/National Guard) benefits, I will need to make proper arrangements to pay the institution for my tuition and fees.
**If you are Ch 30 (MGIB-Active Duty) or Ch 1606 (Reserve/National Guard): If you are in a degree program at a college or university, or a certificate or diploma program at a business, technical, or vocational school, you will not receive payment until you have verified your attendance. Your enrollment can be verified starting on the last calendar day of the month by using our Automated Verification of Enrollment (WAVE) at https://www.gibill.va.gov/wave or by calling the toll free Interactive Voice Response (IVR) telephone line at 1-877-823-2378.

NOTE: The WAVE and IVR systems do not update account information instantly. Instead, verifications and other submissions are stored and processed manually. Due to system procedures, it may take 2-3 workdays for the WAVE and IVR systems to reflect updates to your account. Thank you for your patience. (Per VA)
I certify that the above information is correct and that all courses lead to my declared program of study and are not repeated courses.

I understand that it is my responsibility to report any schedule changes to the Office of Veterans Affairs, and that I must submit this form each term before my class schedule can be certified.
Your E-mail
We will send you an email receipt once we receive your request form.
Signature
Date

MonthDayYear
2 digit month, 2 digit day, 4 digit year
By submitting this form I am stating that I have read and understand the above terms and conditions.
For OFFICIAL USE ONLY
Semester Certification Requested:
Date Certified in VA Once:

MonthDayYear
2 digit month, 2 digit day, 4 digit yearDate
Amount Tuition/Fees Added:
Date Tuition/Fees Added:

MonthDayYear
2 digit month, 2 digit day, 4 digit yearDate
Total Certification Credit:
Date placed on HOLD:

MonthDayYear
2 digit month, 2 digit day, 4 digit yearDate
Date input into BANNER:

MonthDayYear
2 digit month, 2 digit day, 4 digit yearDate
Classes Verified:
COMMENTS:
Should be Empty:

Certification Request Form

Chapter 35 ONLY

For OFFICIAL USE ONLY