Va Form 22-8794 - Designation Of Certifying Official(S) printable pdf download

OMB 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.

1. NAME AND ADDRESS OF SCHOOL OR TRAINING ESTABLISHMENT (Include ZIP Code)

FOR VA USE ONLY

2. TELEPHONE NUMBER(S) OF CERTIFYING OFFICIAL(S) (Include Area Code)

3. FAX NUMBER OF CERTIFYING OFFICIAL(S) (Include Area Code)

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)

VA FORM

SUPERSEDES VA FORM 22-8794, JAN 2002,

22-8794

(See Reverse)

NOV 2003

WHICH WILL NOT BE USED.

Va Form 22-8794 - Designation Of Certifying Official(S)

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