VA Certification Request Form

This form must be completed before the start of each term a student wishes to use their VA Education Benefit funding.

Please note the following before completing this form:

-If you are a new student, or using VA Education Benefits for the first time at Emory you must first complete an "Emory VA Benefits Enrollment Form" located here before completing this form

-This form should only be completed one (1) time. Multiple submissions of this form in a single semester will result in a delay of processing

Student ID

Student Name (Last, First)

Emory School

Email Address

Confirmation of your certification request will be sent to this email.

VA Benefits Program

Please indicate under which VA education benefit you will be using during the semester

Demographic Information Changes

If any of the following items have changed since last semester please list the UPDATED INFORMATION below

Name

Address

Major

Telephone Number

Major

Please indicate your major. If you have not selected one yet please list "Undecided"

Certification Semester

Select the semester for which you are requesting certification

Acknowledgements

Please review the information below carefully and check each box to acknowledge your review:

Enrollment Change Notification Acknowledgement

I understand that I am required to notify the SCO (vacompliance@emory.edu) immediately of any changes to my enrollment status such as drop, add, leave of absence, withdrawal, and change of school/program. I understand that any funds I receive for which I am ineligible will be returned to the VA or the university.

Eligibility Acknowledgement

I certify that I have benefits eligibility to cover the semester for which I am requesting certification

Withdrawal Acknowledgement

I understand that should I drop or withdraw from a single course, or multiple courses up to and including withdrawing from the entire semester that:

-I should notify the SCO (vacompliance@emory.edu) of any "mitigating circumstances" so that this information can be sent to VA.

For information on mitigating circumstances please visit https://www.va.gov/resources/how-your-reason-for-withdrawing-from-a-class-affects-your-va-debt/

I further understand that I may be directly responsible for repayment to the VA for any unearned book and supply payments or housing payments.

I further understand that should the university be required to repay any portion of tuition and fees paid to them by the VA the amount of this repayment will be charged to my Emory student account.

Unrelated Courses Acknowledgement

I understand that the VA will not pay tuition/books & supplies/housing costs for the following types of courses:

-Excessive elective courses over and above the minimum required for my degree and major

-Courses that are not specifically required for my degree unless they are taken to satisfy an unmet minimum elective requirement

-Previously passed courses taken for the sole purpose of improving my passing grade

Send me a copy of my responses

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