VA Certification Request

NOTE: Completion of the VA Certification Request requires reporting certain information to Veterans Affairs such as initial enrollment, VA Educational Benefits already used and change of major/minor. Visit the VA website to report this information.

Last Name: *
First Name: *
College ID: *
SSN: *
Campus: *
Email: *
Dates Covered:
Begin
End

Check if any of the following apply:

I am currently on active duty and will also be using Tuition Assistance (TA). *See Below.I am repeating courses. **See Below.

Please list repeated courses:

This is my first enrollment (ever) of VA Benefits. Report to VA. See above.I have used VA Benefits before, however this is the first term at NC Wesleyan. Report to VA. See above.I have changed my major/minor since last enrollment: Report to VA. See above.I am enrolled in a hybrid or independent study class. ***See Below.

Please list hybrid or independent study class:

Last term I was placed on Academic Warning, Probation or Suspension or had a cumulative GPA under 2.0I will graduate at the end of this enrollment period.

Date of Graduation: *

The information I am providing is true and I understand that: 1. It is my responsibility to notify my SCO of changes in my degree program, drops or withdrawals.
2. It is my responsibility to follow the program curriculum outlined in the College Catalog.
3. If I fail a course due to absences/non-attendance in class, I may be required to repay VA benefits.
4. The SCO will certify my enrollment only after I have completed/renewed this and other relevant forms.
REQUIRED *
Yes, I understand and agree to the four statements above.
Footnotes * CH 1606 must choose VA or TA–they cannot use both together. For CH 33, TA always pays first before VA.
** The VA will only pay for repeating courses in certain circumstances. Ask SCO for more information.
*** Hybrid 8-week classes and Independent Study classes are considered “distance.” Taking two distance/online courses together will reduce your BAH monthly payments.

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