For Va Use Only 22-8794 Designation Of Certifying Official(S)
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2OMB Approved No. 2900-0262
Respondent Burden: 10 Minutes
DESIGNATION OF CERTIFYING OFFICIAL(S)
GENERAL INSTRUCTIONS
1. This form MUST ONLY be completed by a responsible official with the authority to designate certifying officials for the school or
training establishment.
2. This form must be completed whenever there is a change in any of the information. Include the names, titles, and signatures of all
certifying officials, not just the changed information.
SPECIFIC INSTRUCTIONS
1. Item 1: Enter the complete name and address of the school or training establishment.
2. Item 2: Enter the certifying official's telephone number.
3. Item 3: Enter the certifying official's fax number.
4. Item 4: Enter the certifying official's e-mail address. As an alternative, you may enter the e-mail address for the office where the
certifying official works.
5. Item 5A: Enter the complete name and title for each designated certifying official. Have each person sign the form on the same line
as his or her name and title. If any of the certifying officials have limited jurisdiction, note such limitations in Item 6, "Remarks". Use
space below if needed.
6. Item 5B: If facsimile (e.g., rubber stamp) signatures will be used for any certifying officials, enter a sample in the appropriate block.
In addition, have the individual initial next to the sample.
7. Item 5C: If veterans and other eligible persons will be claiming individualized tutorial assistance, complete these blocks.
8. Items 7 and 8: Sign and date the form. The person signing the form must be a person of significant authority, i.e., registrar,
academic dean, or higher.
PURPOSE: This form is used to provide the names and signatures of those individuals who are authorized to certify enrollment information to the
Department of Veterans Affairs.
(Include ZIP Code)
1. NAME AND ADDRESS OF SCHOOL OR TRAINING ESTABLISHMENT
FOR VA USE ONLY
(Include Area Code)
(Include Area Code)
2. TELEPHONE NUMBER(S) OF CERTIFYING OFFICIAL(S)
3. FAX NUMBER OF CERTIFYING OFFICIAL(S)
4. E-MAIL ADDRESS OF CERTIFYING OFFICIAL(S)
5. THE FOLLOWING ARE DESIGNATED AS CERTIFYING OFFICIALS OF THIS SCHOOL OR TRAINING ESTABLISHMENT
A. OFFICIALS DESIGNATED TO SIGN VA ENROLLMENT CERTIFICATIONS, CERTIFICATIONS OF CHANGE IN STUDENT STATUS, CERTIFICATIONS OF DELIVERY OF
ADVANCE PAYMENTS, CERTIFICATIONS OF PURSUIT, ATTENDANCE, FLIGHT TRAINING, ON-THE-JOB OR APPRENTICESHIP TRAINING (AS APPLICABLE), OTHER
CERTIFICATIONS OF ENROLLMENT ARE:
NO.
NAME
TITLE
SIGNATURE
(1)
(2)
(3)
(4)
B. THE USE OF THE FOLLOWING FACSIMILE (e.g., rubber stamp) SIGNATURES FOR THE OFFICIALS LISTED IN ITEM 5A ABOVE ARE AUTHORIZED.
(1)
(2)
(3)
(4)
(See Reverse)
VA FORM
EXISTING STOCKS OF VA FORM 22-8794,
22-8794
MAY 2011
JAN 2007, WILL NOT BE USED.
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