VA Certification Request Form

VA Certification Request Form

This form MUST be completed for each term the student intends to use VA education benefits. All VA beneficiaries are responsible for understanding their benefits and how their registration can affect their entitlements.

Date Completed*

Student ID Number*

Last Name, First Name*

My Veteran Affiliation *

Select or enter value

Do you want to use VA benefits for the semester?*

Yes

Certifying Year *

Year you want certified or amended. Example: 2023 please put "23" or "2023"

Certifying Term*

Select

V.A Benefit Program You Want To Be Certified Under*

Select or enter value

Other - Please specify

I am enrolled in ____Resident (in person) credits*

If you are not enrolled in resident credit hours, please put "0"

I am enrolled in ____Online credits*

If you are not enrolled in online credit hours, please put "0"

I am enrolled in a clinical rotation that has "0" credit hours associated with it.

Please indicate how many hours per week you will be working at your assigned clinical placement.

What is the start date of your term?*

What is the last day of your term?*

Understanding

I understand that I must maintain the required standards of progress towards the degree indicated as specified in my respective University Catalog. I agree to notify the Veteran's Representative at SMU of any changes in my enrollment status. I understand that failure to notify the Veteran's Representative may result in overpayment from the VA Office that may result in those funds being owed back to the Department of Veterans Affairs or SMU.

By Submitting this form, I am confirming the following:

I am eligible to receive VA educational benefits for which I have selected.
I will notify SMU School Certifying Official(s) of any changes to my schedule, enrollment, address, or status as soon as possible following the change.
I assume full responsibility for reimbursement of funds to SMU or the VA should an overpayment occur as a result of this certification. I understand my registration decisions can affect my monthly entitlements.

Send me a copy of my responses

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