Primary/parent Certification Request Form - Santiago Canyon College
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1Veterans Affairs Office
PRIMARY/PARENT CERTIFICATION REQUEST
PRIMARY SCHOOL
SECONDARY SCHOOL
(Student MUST List School & Contact Information)
Santiago Canyon College
Veteran Service Office
Institution:__________________________________
8045 E. Chapman Ave.
Address:____________________________________
Orange, CA 92869
____________________________________
(714) 628-4876
VA Office Phone: (_____) ______ - __________
(714) 628-5099
VA Office Fax:
(_____) ______ - __________
Student Name: _________________________________________
Chapter:____________________________
Student Date of Birth: _____ / _____ / _____
SS# _________________
File Number:__________________
Student Email:_________________________________
Student Phone: (______) ______ - ____________
To be completed by a Santiago Canyon College Counselor or Dean:
Bring a copy of your approved educational plan with you to your counseling appointment.
This is to certify that the above student of Santiago college (Facility Code : ) is pursuing the following educational program:
__________________________________________
The course(s) listed below satisfy the program requirements and will transfer, if completed, at full value to Santiago Canyon
College/Santa Ana College.
Course Title at
Course Title – SCC
Secondary School
Equivalent
Student Intends to take the above course(s) at the above listed secondary school for the
___ Fall ___ Spring ___Summer of __________ (YEAR) term as a guest student for VA educational benefits.
Counselor Name: ____________________________ Counselor Signature: __________________________ Date____/____/____
To be signed by Student: Student responsibility and certification
The certifying Official will submit this letter to secondary school for certification. Please check with them to see if there are other
documents you may need to fill out to complete the certification. Upon completion of the courses listed above, it is my responsibility
to submit Official Academic Transcripts from the secondary institution listed above to Santiago Canyon College’s Admissions &
Records for evaluation. Please do this as soon as your grades for the above course are posted in your Admissions records at the
secondary school.
Student Signature:_____________________________________
Date: _____/_____/_______
STUDENT INSTRUCTIONS: Do not fill out below. After completion of above items, return this form to the VSO A 206-A for
submission to the secondary school. The purple Certification Request form still needs to be filled out for SCC even if may not
be taking any courses at SCC.
To be filled out by the Santiago Canyon College Official:
Dear Secondary School, Please certify courses above totaling_______ Units to the VA as the secondary School ad email or fax me a
copy of the form 22-1999 when submitted to the VA. Thank you!
Certifying Official’s Signature:__________________________________________
Date _____/_____/_______
Certifying Official: Andrea Garcia
Phone: (714) 628-4793
Fax: (714) 628-5099
VA Form – 315
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