Fillable Veterans Administration Educational Benefits printable pdf download

VETERANS ADMINISTRATION EDUCATIONAL BENEFITS

NOT TO BE USED FOR VA VOCATIONAL REHABILITATION BENEFITS (Chapter 31)

REQUEST FOR CERTIFICATION

SYRACUSE UNIVERSITY VETERANS RESOURCE CENTER

700 UNIVERSITY AVENUE, SYRACUSE, NY 13244-2530

(315) 443-9297 / fax (315) 443-6689

This form must be completed for each term you wish to receive benefits.

Term Fall/Spring/Summer 20____

Number credits enrolling this term

(circle one)

(year)

Name

Address

Phone ______________(home)

______________(work)

(mobile)

SUID number_______________ Student SSN__________________ Veteran SSN_________________

Service Branch

Number months of benefits remaining

Education Benefit Chapter

: 30

), 1606

1607

(circle one)

(Montgomery GI Bill

(Selected Reserve),

(REAP)

40% 50% 60% 70% 80% 90% 100%

(Dependent Educational Assistance)

(Post 9/11 GI Bill)

*100% category

processed as Yellow Ribbon, per eligibility criteria

Status

: Active Duty _____Veteran _____ Dependent

Reservist _____

(DEA)______

(check all the apply)

Transfer Entitlement (spouse)____Transfer Entitlement (child)____National Guard ____(

______)

which state?

If Active Duty, will you be using TA? Y / N

If Yes, what amount?$______________________

Degree

: _____________ Program of Study:_____________________________________

(BA/BS/MA etc

Admit Term:_________________ Expected Graduation Term (if known):_______________________

Did you file a FAFSA this year?

Y / N

Do not use this form if you receive VA Vocational Rehabilitation benefits. You must work with your VA Rehabilitation Counselor and submit

direct payment certification requests to Syracuse University Bursar Operations, 102 Archbold North Syracuse NY 13244-1140.

My signature below indicates that I understand that in order to comply with Veteran’s Administration regulations,

Syracuse University’s Veterans Resource Center must submit registration and academic progress reports to the

Veteran’s Administration. Furthermore, I must report any changes in my registration status (listed below)

within two weeks from the date of their occurrence. I also understand that registration changes may affect the

VA Benefit amounts paid to me. A change in my registration can cause overpayment on my VA account, which I

would be required to repay. Additionally, I understand that failure to properly advise the SU Veterans Resource

Center could result in immediate cancellation of any certifications submitted to the Veteran’s Administration.

Registration changes that must be reported

Added Classes

Report the day the add becomes effective

Dropped Classes

Report the last day of attendance in the class

Audit Grades

Report this grade option, if I choose it. The VA will not pay for classes for which I

request an audit grade.

Withdrawals

Report the last day of attendance

Repeated Classes

Report any class I am repeating for credit. The VA will pay for such a class only if the

initial grade was an “F.”

NA or Missing Grade

A class with an “NA” (Never Attended) grade or missing grade will not be paid by the

VA I will be responsible to repay any monies received for these classes.

I have read and understand the above statements and agree to comply.

______________

_________________________________________________________________

Date

Signature

Email (please print)

\\uc-fsrv.ad.syr.edu\kicook$\desktop\va request for certification form_2014.doc

Veterans Administration Educational Benefits

Related Articles

Related forms

Related Categories