Request for VA Certification PRCC Office of Veteran Services
This form must be completed before each semester (fall, spring, summer) that you wish to be certified.
Student ID #:
City, State, Zip:
Telephone #:
Fall □ Spring Summer
Current Year:
Please indicate which Chapter of VA Education Benefits you will be using at PRCC:
□ Ch. 1606 (National Guard/Reservist)
□ Ch. 30 (MGIB-AD)
□ Ch. 33 (Post 9/11)
□ Ch. 31 (Voc. Rehab)
□ Ch. 35 (DEA) What is your VA File Number? (Required for Certification)_____________________________________________
Please indicate your status:
Are you a Veteran or current member of
the US Armed Forces?
□ Yes: If yes, are you on Active Duty?
□ No
□ Yes; anticipated discharge date:
□ No: My relationship to the Veteran/Service Member is: □ Spouse □ Dependent
Which branch of the military did you (or the Veteran) serve in?
□ Army
□ Air Force
□ Coast Guard
□ Marine Corps
□ Navy
□ National Guard/Reserves
Things to remember:
1. The VA will only pay for classes that apply to your degree requirements for graduation.
2. If you’ve changed your major, additional paperwork is required before certification can be completed. It is your responsibility to update this
information with the VA Certifying Official.
3. The VA will not pay for Development/Remedial courses taken online.
4. The VA will not pay for courses that have already been successfully completed (if you have questions about a course, please ask the VA Certifying
Official before scheduling the course).
5. The VA will only pay during the enrollment dates indicated on your printed schedule. Mini-courses, block courses, modified block, summer courses
are considered non-standard terms, and these non-standard terms may affect your pay.
6. If I am the military member/Veteran, I hereby give PRCC permission to request my Joint Services Transcript, and if I am/was a member of the Air
Force, then I will request my CCAF transcript immediately.
7. I understand that all communication will be done via my PRCC student email account.
8. I understand that I must notify the VA certifying official of any changes to my enrollment after I have submitted this form. Failure to notify may
result in overpayment.
I have read and understand the above statements, and it is my responsibility to adhere to stipulations set forth within. I understand that my
account balance is my responsibility, and that I must pay any tuition, fees, books, housing or additional expenses on my account.
Student’s Signature
***Advisor, please indicate the approved courses for the requested term; attach a copy of the PRCC Student Schedule, and
provide a copy of the designated degree plan from either PRCC or the transfer university.
Course Description
Required for
Is this a repeated
*example* English Comp I *example*
I verify that the courses listed above apply towards the students degree requirements for the current enrollment period. *Courses can be required electives.
Signature of PRCC Counselor or Advisor
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