VA EDUCATIONAL BENEFIT CERTIFICATION REQUEST

Purpose: This form is required for students requesting certification of VA education benefits. Submission of this form does not guarantee payment of benefits. Certification cannot occur until all required documentation is received.

Student Information 

VA Benefit Information

VA Benefit Chapter (check one):
Have you previously used VA education benefits?
Are you a Veteran, Active Duty or Dependent?
Dependents will need to provide the name, date of birth, and social security number of the veteran or active-duty service member. Please contact the Financial Aid Office.

Program of Study 

Only courses that are required for the declared program of study may be certified for VA benefits.
Did you change your program or major since the last semester you received benefits?
Term Certification Request
Prior Credit Disclosure

Student Responsibilities & Acknowledgement 

Please read and acknowledge each statement:
Sign above