Certification/Schedule Adjustment Worksheet
VETERANS AFFAIRS CERTIFICATION REQUEST FORM
*Form must be completed electronically or in ink*
Name (Last, First, Middle Initial)
Address (Number, Street or Rural route, and Apt#)
Semester Certification Requested
Schedule Adjustment Request
(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.
Submit this form, with a copy of your CCC&TI schedule, as soon as you have registered. Students using Chapters 1606, 30, and 35,
must secure classes using financial aid, tuition assistance, scholarship, or pay for classes prior to requesting certification. If you have
questions, please contact us at 828-726-2713.
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 myaccount. 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).
By completing and submitting this document, I give permission to the Office of Financial Aid to certify my
Send completed forms to:
Caldwell Community College and Technical Institute
Office of Financial Aid
Caldwell Campus Watauga Campus
2855 Hickory Blvd. PO Box 3318
Hudson, NC 28638 Boone, NC 28607
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