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
One file only.
100 MB limit.
Allowed types: txt, rtf, pdf, doc, docx, odt, ppt, pptx, odp, xls, xlsx, ods.

Student Responsibilities & Acknowledgement 

Please read and acknowledge each statement:
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Photo of Elliott Cotton, from England
Student Profile
Elliott Cotton, England

As a student, I have loved how much the teachers care about you. They want you to succeed in whatever you want to do and are always willing to help. It makes it much easier to cope with change and classes that aren't your strong suit.

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Abby Davidson
Student Profile
Abigail Davidson

I always found inspiration from my professors at NJC who made me laugh, and encouraged me to be the best I could be.  Eventually I would like to use my skills to become a video game programmer or designer.

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Photo of Garrett
Student Profile
Garrett Cockroft

With encouragement from my concurrent enrollment connections, I have become heavily involved on campus and was elected to be the current Associative Student Government President along with other leadership roles.

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