2020-21 Veterans Affairs
Certification/Schedule Adjustment Worksheet
*Worksheet must be completed electronically or in ink*
Name (Last, First, Middle Initial)
Address (Number, Street or Rural route, and Apt#)
Student ID
Address 2
Phone Number
City
State
Zip
Semester Certification Requested
:
Fall
Spring
Summer
Schedule Adjustment Request
:
Yes
No
(Classes added or dropped
after initial certification
request)
Has your program of study
changed since the last certification
? NO YES
If yes, please complete the 22-1995 (Veteran & 33TOE) or the 22-5495 (Ch. 35 & FRY) and submit with this form.
Read and initial each statement.
I am required to submit a new Certification Request Form each semester.
I understand onlycourses required for graduation can be certified.
After requesting certification, a registration hold will be placed on my account. I am required to contact the Office of
Financial Aid to remove the registration hold before making adjustments to my class schedule.
Changes to my schedule (drop/add/withdrawal), & excessive absences (of one week or more) must be reported to the
Office of Financial Aid immediately to avoid financial liabilities.
If my status changes to Academic Suspension, I am no longer eligible to be certified. If my cumulative grade point average
(GPA) is below a 2.0, I will be placed on Academic Probation. While on Academic Probation, I must maintain a grade
point average of 2.0 or higher to maintain satisfactory progress and continue using my VA education benefits.
For Chapter 1606 and 1607 students only: CCC&TI’s VA Certifying Officials are not permitted to certify classes for benefits
under Chapter 1606 or 1607 if the student is receiving Federal Tuition Assistance for the class. This does not apply to students using
NC State Tuition Assistance (NCTAP).
I give permissionto theCCC&TIOffice of Financial Aid tocertify my required courses.
Signature: _________________________________ Date:
For Office Use Only:
Award Codes and Amount: $1,800 (Voc. Rehab. Only)
Date Certified in VA Once: __________________
VAMGI (Chapter 30, 35, 1606, 1607)
CRI Com Code: FA19VCER
VRCU (Voc. Rehab. Curriculum) SAXL (Charge Restriction)
PERC:
VRCE (Voc. Rehab. Cont. Education) SAXL (Charge Restriction)
Bookstore Voucher Created (Chapter 31 only):
VASCH (Dependents of Vets)
V33CU (Chapter 33 Curriculum)
V33CE (Chapter 33 Cont. Education)
Return completed worksheet(s) to:
Caldwell Community College and Technical Institute
Office of Financial Aid
E-mail finaid@cccti.edu
Caldwell Campus 2855 Hickory Blvd., Hudson, NC 28638 Watauga Campus PO Box 3318, Boone, NC 28607
click to sign
signature
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