Fillable School-Enrollment CHAMPVA School Enrollment Certification Letter

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School-Enrollment CHAMPVA School Enrollment Certification Letter

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Department of Veterans Affairs
VHA Office of Community Care
CHAMPVA Eligibility
PO Box 469028, Denver CO 80246-9028
CHAMPVA School Enrollment Certification Letter
Children between 18 and 23 years of age must submit a school enrollment certification letter
confirming full-time student status. This is required in order to continue eligibility for CHAMPVA
benefits. Detailed information about school certification requirements are documented on Fact Sheet
01-15: CHAMPVA School Certification Requirements which can be viewed on the VHA Office of
Community Care website at http://www.va.gov/purchasedcare/pubs/factsheets.asp.
Questions should be sent to the VHA Office of Community Care (VHA CC) at the address listed
above or via the CHAMPVA toll-free customer service number: 1-800-733-8387, Monday through
Friday from 8:05 a.m. to 7:30 p.m., Eastern Standard Time. VHA Office of Community Care can also
be contacted by email using the VA Inquiry Routing and Information System (IRIS). Please go to the
IRIS website (https://iris.custhelp.com/app/ask/) and complete the online form.
To submit a student's full-time enrollment status, please have a school official complete this form and
submit it to the address listed above. For immediate processing, have the school FAX the enrollment
certification to (303) 331-7809.
NOTE: School enrollment certification letters must be faxed directly from the school in order to be
considered valid.
School Enrollment Certification
Student's Last Name First Name MI Last Four Digits of SSN
Name of Educational Institution
Enrolled Status:
Full-time Part-time
School Term Start Date (mm-dd-yyyy) School Term End Date (mm-dd-yyyy) Estimated Graduation Date (mm-yyyy)
Signature of School Official Title of School Official
Date signed
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School-Enrollment CHAMPVA School Enrollment Certification Letter

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Completed 23 June 2020

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