CALIFORNIA STATE UNIVERSITY, EAST BAY – VETERANS AFFAIRS OFFICE, STUDENT ADMINISTRATION BUILDING
25800 CARLOS BEE BOULEVARD, HAYWARD CA 94542 | (510) 885-3669 PHONE | (510) 885-3816 FAX
VETERANS REQUEST FOR CERTIFICATION (VRC) FORM
IMPORTANT: All requested information must be completed and this form signed in order to process your certification. This form
must be submitted to the Enrollment Information Center in the SSA building or emailed to
from your Horizon
account. Certification beyond this term is NOT automatic. It is your responsibility to ensure that your benefits continue by submitting
the VRC each quarter by the priority deadline. All correspondence regarding your benefits will be sent to your HORIZON email account.
New Applicants: Always allow the USDVA at least 6 – 8 weeks to process your application and payment.
If you have used benefits previously, please allow the USDVA at least 30 days to process your payment.
NAME:______________________________________________ Net ID:__________ SSN/VA File# ________ -_______ -___________
TERM (PLEASE CHECK ONE):
Type of Benefits:
Chapter 30/34 (Montgomery GI Bill)
Chapter 31 (Voc. Rehab.)
Chapter 32 (VEAP)
Chapter 1606 (Reservists)
Chapter 1607 (REAP)
Chapter 33 (Post-9/11) Veteran
Chapter 35 (Dependents): File # ________________________
Chapter 33 (Post-9/11) TEB-Dependent
CONTACT INFORMATION (Remember to update MyCSUEB!)
City:_____________________ State:______ Zip:____________
Phone #: (
Option (must be formally declared):_______________________
Report address change to VA?
Major or Minor: ________________
I am a:
First Time Freshman
I am a(n):
OFFICIAL USE ONLY:
Expected quarter of graduation:
Are your receiving any of the following grants? (Ch. 33 recipients only)
Cal Vet/College Fee Waiver
State University Grant
* See Veterans Benefits Coordinator for additional forms required for certification.
WAIT! Have you enrolled in classes? This form must be submitted AFTER you enroll in classes. Incomplete forms will not be processed and will be
returned to the student. You will only be certified for classes in which you are enrolled – these classes must satisfy one or more of the following
degree requirements: General Education, Program/Major, University requirements. If you change your unit load (add/drop/withdraw), you must
notify the Veteran Benefits Coordinator by email at firstname.lastname@example.org within one week of any change to your academic situation.
If this class will be taken at another
- GE (area and number, e.g., B6, D4)
Institution, please indicate the
- Major (core, option, elective)
name of the Institution and attach a
- University (CGW, Code, unit req.)
copy of your proof of enrollment in
**must be verified by GE evaluation
this class so that a Parent School
(e.g., ENGL 1001)
and/or major degree plan
Letter* can be sent to the Institution.
Are you repeating any classes?
If yes, list class(es), term(s) previously taken and grade(s) received:___________________________________________
Student Statement of Understanding
I am aware that it is my responsibility to keep the Veterans Affairs Office informed of my true academic situation (i.e., changes in program, units, withdrawal, etc.).
I realize that I am liable for the repayment of benefits awarded through a claim based on false or misleading statements.
Revised 10/14 DDH