Veterans Certificate Request

Veterans Certificate Request Form

Scripps College

Office of the Registrar

Registrar@scrippscollege.edu

Name

First Name

Last Name

Student ID#

VA File #

Major(s)

Local Address

Address Line 1

Address Line 2

City

State

ZIP Code

Phone

Email

Number of courses Fall term

Number of courses Spring term

Under which chapter are you requesting to be certified?

Chapter 30: Montgomery GI Bill Chapter 31: Vocational Rehabilitation and Employment* Chapter 32: Veterans' Educational Assistance Program Chapter 33: Post 9/11 GI Bill** Chapter 35: Dependents' & Survivors' Educational Benefits Chapter 1606: Selected Reserve Chapter 1607: Reserve Educational Assistance Program

Payable benefit for Chapter 33 (%)

Submit this form along with your certificate of eligibility:

*Chapter 31 also requires an Application for Dependent Education Benefits.

**If you are applying for the Yellow Ribbon Program, please include the Yellow Ribbon Benefits Request Form.

Status

Yes, I am on Active Duty I am using benefits through a Transfer of Entitlement

Name of veteran

I understand that:

By signing this form, I authorize Scripps College to certify my enrollment and provide academic record information to the Department of Veterans Affairs to ensure the receipt of Educational Training Benefits.
Certifications will be reported based on the number of courses I am enrolled in per semester.
It is my responsibility to notify the Registrar's Office of changes to my class schedule. Any changes in my registration status or enrollment (i.e. add, drop, withdrawal) may affect the VA benefit amount I receive.
I am responsible for any overpayment of benefits resulting from these changes.
It is my responsibility to report if any certification/benefit information changes.

Signature

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Use your mouse or finger to draw your signature above