Veteran Educational Benefit Request Form - Edinboro University
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1
2Veterans Success Center
Crawford 208A 200 Glasgow Road Edinboro, PA 16444
(814) 732-1568
phone:
fax:
(814) 732-2568
email:
veterans@edinboro.edu
Veteran Educational Benefit Request Form
Request to Certify Enrollment to Department of Veterans Affairs
STUDENT INFORMATION:
________________
Student ID#: _________________ Social Security #: ____________________ VA File # (if not SSN):
Phone Number: _________________________________ Student Email: _____________________@scots.edinboro.edu
Name: Last ________________________________________ First ______________________________________ M.I. ________
Address: ________________________________________________________________________________________________
Street
City
State
Zip Code
Program: Associate Degree Bachelor Degree Graduate Program
Major *: _________________________________
*If this is a major change, VA Form 22-1995 or 22-5495 is required. Please go to
to submit form.
Term and Credits **:
Fall 20___ Credits ____ Winter Session 20___ Credits ____ Spring 20___ Credits ____ Summer 20___ Credits ____
st
nd
rd
Internship (1) Credits ____
1
(D) Credits ____
2
(E) Credits ____
3
(F) Credits ____
**Must have class schedule before certification can be submitted.
Please check as applicable:
Type of VA Benefits:
Applied online (VONAPP) for Education Benefits
Chapter 30 (Montgomery GI Bill)
Application form (VA Form 22-1990) attached
Chapter 31 (Vocational Rehabilitation)
Advance Payment, if available; see information on reverse
Chapter 33 (Post-9/11 GI Bill)
Chapter 35 (Dependent/Survivor)
Chapter 1606 (Reserves/National Guard)
Chapter 1607 (REAP)
INSTRUCTIONS:
This form is needed for each semester and should be submitted as soon as the student has applied or scheduled for each term. If any changes
occur in your enrollment status (increase or decrease of credit load), you must immediately notify the Veterans Success Center.
NOTICE OF PROHIBITION OF PAYMENT OF BENEFITS:
Circumstances not eligible for payment:
Course Withdrawal - No payment of education benefits shall be made to an eligible student for non-punitive grades. This includes courses from
which the eligible student withdraws, unless mitigating circumstances (as determined by the Department of Veterans Affairs) are involved in
the withdrawal. A non-punitive grade is any grade assigned for pursuit of a course (whether upon completion of the course or at the time of
withdrawal from it) which has the effect of excluding the course from any consideration in determining progress toward fulfillment of
graduation requirements (e.g.: W, WP, WF grade).
Remedial Course - No payment of education benefits shall be made to an eligible student for remedial courses that are not counted for credit
toward meeting degree requirements.
Repeated Course - Payment of VA entitlement may be authorized for repeated courses only if the University specifically requires repetition of
the course for attainment of the student’s approved program objective, and if overall satisfactory progress standards are met. If a passing grade
of “D” is initially received for a course, the student may not receive benefits based on re-enrollment in the course unless the University requires
a grade of “C” or better for that course. The Department of Veterans Affairs will not authorize payment for a repeated course in which the
student fails to improve his previous grade. Under no circumstance can an eligible student be certified for VA benefit payments based on
enrollment in a course in which he previously received a grade of “C” or better.
REQUIRED SIGNATURE:
I have read and understand the instructions and policies printed above.
Student Signature: ___________________________________________________________ Date: ________________________
Turn-in Completed Form to the Veterans Success Center each term, or after making an enrollment/program change.
Created: 06/30/2006 | Revised: 09/18/2013
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