GI Bill® Certification Worksheet

GI Bill® Certification Worksheet
Name

First NameLast Name
RIC Student ID Number
Current Program of Study / Major
Phone Number

Area CodePhone Number
Email
example@example.com
VA Education Benefit: Please check your current chapter status
Chapter 31 VR&E Case Manager Name
Are You the Veteran's
Using a STAP Waiver
Using Disabled American Veteran (DAV) Waiver
Please Indicate the Semester You Need Certification
Total Registered Credits
Are You Completing a Clinical or Internship Placement This Semester?
Location
Is It Your Intent to Waive RIC Accident and Health Insurance?
* It is the student's responsibility to waive health insurance from their account. Indicating "Yes" on this form does not result in your insurance being waived.
Initials
Important Info Regarding Your VA Payment

Please check that you read and understand the information:

Notify the Certifying Official immediately if you change your schedule, drop a class, withdraw from a class, etc. Also, it is your responsibility to provide verification of Mitigating Circumstances.

Signature Required: I attest the information above is true and accurate. I understand that I am responsible for any unpaid balance that the VA does not cover. This is a RIC form and must be completed every semester.
Signature
Date

MonthDayYear
Date
GI Bill® is a registered trademark of the U.S. Department of Veterans Affairs (VA). More information about education benefits offered by VA is available at the official U.S. government Web site at http://www.benefits.va.gov/gibill.
Should be Empty:

GI Bill® Certification Worksheet

Important Info Regarding Your VA Payment