Request for 22-1999 Enrollment Certification VA Form

1 Request for 22- 1999 Enrollment Certification VA form I Request for my 22- 1999 Enrollment Certification VA form to be certified and sent to the Veterans Administration for processing of my Military Education Benefits. I understand that my courses will not be certified without notification to the Veteran Affairs Representative each semester. I also understand that I must notify the Veterans Affairs Representative at Iowa Central if my Enrollment changes during a given term by add, drop, or withdraw. Listed below is the term that I Request to be certified for my Montgomery GI Bill and the number of credits that I am enrolled for that term. Please Print: Name_____. Student ID# or SS# _____. Term to be certified_____.

2 (only one term per form ). Number of credit hours enrolled for the above term_____. Applied for Financial Aid (Grants and Loans)? Yes No Using Federal Tuition Assistance (GOARMY)? Yes No Using State National Guard Education Assistance Program? Yes No _____ _____. Sign Date Office Use Only: Transcripts on File: Degree Audit Verified: VETS Screen: Verified FA.