REQUEST FOR VETERAN BENEFITS CERTIFICATION-Westcliff University

REQUEST FOR VETERAN BENEFITS CERTIFICATION
Phone: (949) 835-3812 Fax: (949) 569-8019 Email: Military@Westcliff.edu
Student Information
First Name*
MI
Last Name*
DOB (mm/dd/yy)*
Address*
City*
State*
Zip code*
Phone Number*
Please enter a valid phone number.
Email*
example@example.com
SSN*
Student ID*
Education Information*

Bachelors DegreeMasters DegreeMasters DegreeDoctoral DegreeUndergraduate CertificateGraduate CertificateGraduate CertificateDoctoral Certificate
Major*
Concentration*
*To be certified for educational benefits, you must be enrolled in a PROGRAM APPROVED BY CSAAVE AND BE REGISTERED FOR CLASSES LISTED IN YOUR EDUCATION PLAN.

If you fail to do this by your second session, your VA benefits will stop! If you have any questions, contact your VA Certifying Official at (949) 835-3812.
Benefit Information
Please check benefit program you are applying for.

REAP (Chapter 1607)Reserves G.I. Bill (Chapter 1606)G.I. Bill (Chapter 30)Post 9/11 G.I Bill (Chapter 33)Dependent Benefits (Chapter 35)Voc. Rehab (Chapter 31)
Please indicate the number of units you are enrolled in. (ONE certification per term)*

Fall 1[8W]Fall 2 [8W]Spring 3 [8W]Spring 4 [8W]Summer 5 [8W]Summer 6 [8W]
No. of Units*
Undergradute 6 Units Full-Time, Graduate and Doctoral 3 Units Full-Time
I request that Westcliff University, submit the appropriate forms to the Veterans Administration. I also give the University permission to notify the VA if I change my unit status, make unsatisfactory academic progress, or withdraw from school and to furnish other information requested by the VA in regards to this claim. I understand that it is my responsibility to notify the Certifying Official immediately of any changes or withdrawals. Failure to do so in a timely manner may result in an over payment by the VA Administration for which I may be required to repay.
Signature*

Clear
Date*

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Date
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REQUEST FOR VETERAN BENEFITS CERTIFICATION

Student Information

Benefit Information