VETERANS CERTIFICATION FORM
Please provide all information requested on this form. Submit this form every semester. An email is sent to your Bucks email
address to confirm certification. Please know that an incomplete form may delay certification.
NAME: _________________________________________ STUDENT No. _______________________
ADDRESS: _____________________________________________________________
_____________________________________________________________ Thank you for your service.
CITY: ________________________ STATE ______ ZIPCODE _________________
MAJOR or PROGRAM: ____________________________________________ Note: Submit Form 22-1995 if changing your major or institution.
SOCIAL SECURITY NUMBER _____________________________ PHONE ____________________________(Cell/Home)
APPLYING FOR BENEFITS FOR: FALL/ SPRING/ SUMMER/ 20___ Have you ever collected VA Benefits at Bucks? NO______ YES_______
If YES, when was the last semester that you collected benefits? __________________
Education benefit you are seeking:
Post-9/11 GI Bill®
(Chap.33 %________)
Transfer of Benefits (TOB), Post 9/11
(The veteran must have ACTIVE as of
1 Aug 2009) Submit Form22-1990E to
VA
Montgomery GIBill®-Active Duty
Education Assistance (Chap. 30)
Montgomery GI Bill®-Selective Reserve
Education Assistance(1606)
Montgomery GI Bill®-Reserve
Education & Assistance Program(REAP)
– (Chap. 1607)
Vocational Rehabilitation (Chap. 31)
VA File Number ________________
Survivors’ and Dependents’
Educational Assistance (Chap. 35)
VA File Number ___________________
*IMPORTANT NOTE: Veteran students are
eligible for returning student priority
registration each semester.
I have registered for:
By checking each box below, I acknowledge that it is my responsibility to:
Not repeat any course previously taken or completed except as permitted by VA regulation.
Notify Bucks County Community College’s Certifying Official (in Admissions) of ANY changes to my course enrollment, address, or
major.
Assume full responsibility for any debts owed to Bucks or the VA should I withdraw, be withdrawn for non-attendance, drop, or receive
an over-payment.
Understand that hybrid courses are not considered “in residence,” and are, therefore, treated as “distance learning.” The number of
hybrid courses enrolled for a given semester or term may affect my BAH.
Understand that any and all bookstore charges are my responsibility. Failure to pay these charges prior to the end of a given semester
or term may prevent me from registering until my account is paid in full.
Understand that only courses which are required by my program of study (major)* will be certified. Any courses undertaken which are
not part of required coursework are, therefore, my responsibility for payment of tuition/fees.
Signature: ________________________________________________ Date: ________ Rev. 09/16
Bucks County Community College does not discriminate in its educational programs, activities, or employment practices based on race, color, sexual orientation,
disability, age, religion, ancestry, veteran status, union membership, or any other legally protected category.
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