Va Form 21-8960-1 - Certification Of School Attendance Or Termination

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File Number:

Name of Student:

Birth Date of Student:

Because we are paying Department of Veterans Affairs benefits based on your report that the student named above is attending school,

we ask that you verify the student's school attendance for this school year. Please answer the questions below, sign and date the form,

and return it within 60 days to the VA office address shown above. Otherwise, benefits based upon the student's attendance will be

discontinued.

DEPARTMENT OF VETERANS AFFAIRS

OMB Control No. 2900-0458

Respondent Burden: 10 minutes

Expiration Date: 10/31/2017

CERTIFICATION OF SCHOOL ATTENDANCE OR TERMINATION

1. IS THE STUDENT NOW IN SCHOOL?

(If "No," do NOT complete Items 2 and 4.

YES

Give the date and reason school attendance terminated)

(If, "YES," give the date)

2. HAS THE STUDENT ATTENDED SCHOOL FROM THE OFFICIAL BEGINNING OF THE SCHOOL YEAR?

3. IS THE STUDENT MARRIED?

(If "No," enter the inclusive dates of

YES

the student's school attendance)

5. HAS THE STUDENT ATTENDED ANY OTHER SCHOOL(S)

4. NAME OF LAST SCHOOL ATTENDED

6. WHEN DOES THE STUDENT EXPECT TO GRADUATE

THIS YEAR?

OR OTHERWISE TERMINATE THE COURSE OF

(Give date)

STUDY?

YES

7. HAS THE STUDENT BEGUN RECEIVING OR APPLIED FOR VA DEPENDENTS' EDUCATIONAL ASSISTANCE (DEA), FEDERAL EMPLOYEES' COMPENSATION

ACT PAYMENTS, OR BENEFITS FROM ANY OTHER FEDERAL AGENCY SUCH AS THE U.S. SERVICE ACADEMY, U.S. MERCHANT MARINE ACADEMY,

BUREAU OF INDIAN AFFAIRS, ETC., THAT IS OR WILL BEGIN TO PAY THE STUDENT'S TUITION?

YES

(NOTE: Concurrent receipt of DEA benefits by the student and additional compensation payments based on that student's school attendance is

considered a duplication of benefits and is prohibited)

NOTE: The student should sign this form only if the student is receiving benefits in his or her own right. Otherwise, the parent, guardian, or custodian should sign in

Item 8 and enter his or her relationship to the student in Item 9.

I AGREE to notify the Department of Veterans Affairs immediately of any changes in this course of education, transfer to another school, discontinuance of school

attendance or marriage prior to completion of the course. I understand that continued entitlement to school attendance benefits may be based on the information I have

furnished on this form. Any benefits allowed due to this certification will be discontinued if the student marries or leaves school, or upon the death of the student.

I CERTIFY THAT the information provided is true and correct to the best of my knowledge and belief.

8. SIGNATURE

9. RELATIONSHIP TO STUDENT

10. DATE SIGNED

(Include Area Code)

(If Applicable)

11. DAYTIME PHONE NUMBER

12. EVENING PHONE NUMBER

13. E-MAIL ADDRESS

PRIVACY ACT NOTICE: The VA will not disclose information collected on this form to any source other than what has been authorized under the Privacy Act of 1974 or Title 38, Code

of Federal Regulations 1.576 for routine uses (i.e., civil or criminal law enforcement, congressional communications, epidemiological ore research studies, the collection of money owed to

the United States, litigation in which the United States is a party or has an interest, the administration of VA programs and delivery of VA benefits, verification of identity and status, and

personnel administration) as identified in the VA system of records, 58VA21/22/28, Compensation, Pension, Education, and Vocational Rehabilitation and Employment Records - VA,

published in the Federal Register. Your obligation to respond is required to obtain or retain benefits. The requested information is considered relevant and necessary to determine maximum

benefits under the law. The responses you submit are considered confidential (38 U.S.C. 5701). Information submitted is subject to verification through computer matching programs with

other agencies.

RESPONDENT BURDEN: We need this information to determine continued eligibility to benefits for a veteran's child who is over age 18 and attending school (38 U.S.C.). Title 38,

United States Code, allows us to ask for this information. We estimate that you will need an average of 10 minutes to review the instructions, find the information, and complete this form.

VA cannot conduct or sponsor a collection of information unless a valid OMB number is displayed. You are not required to respond to a collection of information if this number is not

displayed. Valid OMB control numbers can be located on the OMB Internet Page at If desired, you can call 1-800-827-1000 to get information on

where to send comments or suggestions about this form.

PENALTY: The law provides severe penalties which include fine or imprisonment, or both, for the willful submission of any statement or evidence of a material fact, knowing it to be false,

or fraudulent acceptance of any payment to which you are not entitled.

VA FORM

21-8960-1

SUPERSEDES VA FORM 21-8960-1, JUN 2011,

OCT 2014

WHICH WILL NOT WILL BE USED.