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Veteran's Certification Request

Your Information
VA Benefit
Select your VA Education Benefit?
Academic Program Information

(Your program must agree with that listed in the college’s official record)

Course 1
Course 2
Course 3
Course 4
Course 5
Course 6
Course 7
Course 8
Course 9

The completion of this form authorizes the School Certifying Official to certify my enrollment and provide academic record information to the Department of Veteran Affairs to ensure the receipt of Educational Training Benefits. I understand that I must complete this form each semester to receive benefits. It is my responsibility to notify the Veterans Certification Department immediately upon adding, dropping or withdrawing from a course.