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Returning Student Veteran's Certification Request Form

Please note: Form for returning students only.
Full Name:
Street Address:
City, State, Zip Code:
Phone Number:
Email Address:
VA Benefit Type:
Degree/Major:
Are you currently on active duty?
Yes No
Are you receiving federal funds for tuition costs (excluding title IV funds)?
Yes
No
Have you changed your major?
If yes, please submit VA form 22-1995 (for veterans) or VA form 22-5495 (for dependents or spouses) to the University of Richmond's School Certifying Official.
Yes
No

READ, COMPLETE, AND SIGN

I am applying for VA Educational Benefits for the following term and credit hours/units,

Fall

Spring

Summer

Year:
Credit Hours/Units:

I understand that I will not receive benefits for courses in which I have previously earned credit and will not receive benefits for courses that do not apply toward degree completion in my chosen major. Additionally, all the courses I am currently registered for will count toward my degree.

Further, I understand that I am responsible for reporting all adds and drops that change my initial enrollment to the University of Richmond VA Certifying Official, who will subsequently report the change to the VA Office in Buffalo. I also understand that I may be subject to REPAYMENT when my enrollment is misrepresented and all changes are not fully disclosed and reported to the VA Office in Buffalo.

* Type Full Name:
* Date (MM/DD/YYYY):