VA Certification Request

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Veteran Benefits Online Forms

VA Student In-Processing Form
VA Certification Request
VA Yellow Ribbon Application
Military Leave of Absence Form

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.

Name *

First

Last

College ID: *

SSN: *

Email *

Campus Location:

Dates Covered:

List beginning coverage and ending coverage.

Select if any of the following apply:

I am currently on active duty and will also be using Tuition Assistance (TA). See Footnote #1 Below.*
I am repeating courses. See Footnote #2 Below.**

Please list repeated courses:

Select if any of the following apply:

This is my first enrollment (ever) of VA Benefits. Report to VA. Note above.
I have used VA Benefits before, however this is the first term at NC Wesleyan. Report to VA. Note above.
I have changed my major/minor since last enrollment: Report to VA. Note above.
I am enrolled in an online or independent study class. See Footnote #3 Below.***

Please list hybrid or independent study class:

Check all that apply:

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

Expected Graduation Month and Year: *

If graduating this semester, enter month and year of graduation.

The information I am providing is true and I understand the following statements: *

It is my responsibility to notify my SCO of changes in my degree program, drops or withdrawals.

I understand that: *

It is my responsibility to follow the program curriculum outlined in the University Catalog.

I understand that: *

If I fail a course due to absences/non-attendance in class, I may be required to repay VA benefits.

I understand that: *

The SCO will certify my enrollment only after I have completed/renewed this and other relevant forms.

Footnotes

1- *CH 1606 must choose VA or TA–they cannot use both together. For CH 33, TA always pays first before VA.
2- **The VA will only pay for repeating courses in certain circumstances. Ask SCO for more information.
3- ***Hybrid 8-week classes and Independent Study classes are considered “distance.” Taking two distance/online courses together will reduce your BAH monthly payments.