Va Form 22-1999 - Enrollment Certification Request Form printable pdf download

(REVISED

2015)

Enrollment Certification Request form (VA FORM 22-1999)

Office of Veterans Affairs, University of Tennessee, Knoxville

209 Student Services Building, Knoxville, TN 37996

Fax 865-974-8517

This form must be completed by all students using VA education assistance. It must be completed

each semester, failure to do so will result in non-payment for that semester. If this is your first

semester as a new student or new transfer student at UTK you will need to submit your letter of

eligibility from VA along with this form to our office. You may return this form to us by US mail, email,

fax, or in person. If you need more information please contact the UTKVA office at utkva@utk.edu.

PLEASE COMPLETE ALL INFORMATION

NAME (last, first, middle initial)

MAJOR

UTID #

SSN

MINOR

Veteran

Dependent

Spouse

Concentration

ADDRESS

Catalog Year

Term of Graduation

This form is

for the term

PHONE

UT EMAIL

CHAPTER #

If you are active duty check here

**** If you are using chapter 35 please list the

SSN or VA File # of the person whose benefits you are using

****

My level is (check one)

Undergraduate

Graduate

Phd

Exec MBA

Law

Vet Med

Are you pursuing ROTC Commission or receiving TA or GO ARMY ED (check one)

YES

— This form must be turned in 2 weeks prior to payment due date to receive fee extension. Student is responsible

for payment on the last day of term if VA has not made payment.

— Post 9/11 students will receive a stipend based on entitlement (unless you are a spouse of an active duty service

member) stipend is paid one month behind and based on enrollment. Rate is E-5 with dependents based on zip

code 37996. BAH is reduced for less than full time and not paid for “1/2 time or less” enrollment. Full time

enrollment for fall and spring is; Undergraduate 12 hours, Graduate 9 hours. For summer training time please visit

this link

— Post 9/11 recipients will also receive a book stipend based on entitlement. Academic year max (August 1-July 31)

is $1000.00.

— This form will be processed after enrollment in classes. You must notify the UTKVA office of any schedule

changes within 7 days. Changes made to your schedule could cause a change to your tuition and fees. Dropping

a class could cause you to be in overpayment with VA.

— You understand the VA will not pay for courses that are not required in my degree program. VA will only pay for

study abroad courses if your program requires you to study abroad for completion of your degree.

— If you are a Chapter 30, 1606, or 1607 recipient you must verify attendance with the VA monthly via WAVE at 1-

888-823-2378. VA payment rates can be found on the VA website.

— By signing this document below you have read and understood the above statements. Receipt of this form by our

office will allow us to process benefits. During peak times this may take up to 6 weeks.

SIGNATURE

DATE

Va Form 22-1999 - Enrollment Certification Request Form

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