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Veteran's Certification Request Form
Veteran's Certification Request Form
This form must be completed each semester.
Please don't fill out this input box.
Completion of this form authorizes SUNY Schenectady to provide required information, and to certify your enrollment at SUNY Schenectady, for the specified semester, to the U.S. Department of Veterans Affairs (VA). This form is required each semester.
Semester
*
Please Select
Fall
Spring
Summer
Year
*
Major/Program of Study
*
Full Name
*
Last, First, Middle Initial
Address
*
City/State/Zip
*
Phone
*
Email
*
It is your responsibility to keep the VA and SUNY Schenectady informed of changes in your contact information.
Social Security Number
SUNY Schenectady Student ID#
*
Select the VA Benefit Program you are using or wish to use:
*
Please Select
CH 33 (Post 9/11 GI Bill®)
CH 31 (Disabled/Voc Rehab)
CH 1606 (Reserve/Guard)
CH 30 (Montgomery GI Bill® - Active Duty)
CH 35 (Survivors/Dependents Ed Asst Prog)
What is your major?
*
Have you changed your major and/or program since your last certification request?
*
Please Select
Yes
No
If yes, VA Form 22-1995 or 22-5495 (CH 35) must be submitted.
Is this a change in VA benefit chapter from the previous semester?
*
Please Select
Yes
No
The Certifying Official must have a copy of your Certificate of Eligibility letter on file.
Benefit Status
*
Please Select
Continuing Student: Have received beneftis at SUNY Schenectady
New Applicant: Applying for VA benefits for the first time
Transfer Student: Transferring from another institution where you used veterans benefits
Enrollment Agreement
*
I will report any registration changes (add, drop, withdrawal, etc.) and address/phone or course of study changes to the certifying official.
I understand any class changes could result in a delay of payments to me.
I understand that any kind of withdraw may result in reduced payment from the VA.
I understand that classes scheduled to meet for less than the normal semester term dates may be paid at a different rate based on the number of credits and the length of the class.
I understand that only courses which satisfy degree requirements will be certified.
I understand that if I fail to comply with the above, it can result in an over or underpayment of benefits. The VA will hold me responsible for overpayment of my education benefits.
You are encouraged to apply for Financial Aid, as the VA payments may not begin until after the semester has begun.
Please Note: The VA will certify claims in the order received. Omitted information can result in delays. My signature below indicates that I understand the above guidelines, and that I know I must complete a new Veterans Cetifcation Reuest form each semester for which I wish to receive benefits.
Digital Signature
*
Date Signed
*
Form UUID
Site Name
Submit
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