VA Certification Request Form

VA Certification Request Form - 2023FA

Financial Aid Office | 309.341.5321 | vets@sandburg.edu
Name*

First NameMiddle NameLast Name
Student ID*
Phone Number*
Please enter a valid phone number.
Address

Street Address

Street Address Line 2

CityState

Zip Code
Email Address*
example@example.com (use an email you monitor regularly)
Social Security # / VA File #
Information will be encrypted upon submission.
Please Check One of the Following:*

I am enrolled and want to be certified for veteran's benefits for this term. (Select your program(s) below)I plan to enroll later and want to certified for veteran's benefits for this term. (Select your program(s) below)I am enrolled but DO NOT want to be certified for veteran's benefits for this term.
Federal VA Benefits Programs
State Veterans Benefits Programs
I am a new student or I have changed my program of study:*

YesNo
Check this to indicate that you have read and understand the following:*

I understand that I will only be certified for courses that are required by my program of study. I also understand that I am responsible for repayment of Educational Assistance Benefits issued to me for courses that I do not complete. I authorize release of my school records to the VA in order to comply with required reporting and certification. All Carl Sandburg students receiving financial assistance through the VA must satisfy the requirements of the college's Satisfactory Progress for Veterans, maintaining a cumulative 2.0 GPA on a 4.0 scale. Failure to do so may result in ineligibility for benefits.
Date

MonthDayYear
Signature*

Clear
Should be Empty:

VA Certification Request Form - 2023FA