VA Certification Request Form
The completion of this form authorizes Los Angeles Pacific University Veterans Certifying Official to provide required information and to certify your enrollment at Los Angeles Pacific University for a specified semester to the U.S. Department of Veterans Affairs (DVA). This form must be submitted to the Los Angeles Pacific University Veterans Certifying Official each semester you plan to attend Los Angeles Pacific University to receive VA benefits.
Name
*
First Name
Last Name
Email
*
example@LAPU.EDU
Student ID #
*
VA File #/SSN
*
VA/DOD Education Benefits
*
Ch30- Montgomery GI Bill
Ch31 Veteran Readiness and Employment
Ch33- Post 9/11
Ch35- Dependents Education Assistance
Ch1606/1607
VA Benefits Exhausted
Tuition Assistance
Please Upload Tuition Assistance Approval
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Term
*
Please Select
Spring
Summer
Fall
Year
*
Please Select
2020
2021
2022
2023
Please Select
Course Status
Enrolled
Dropped
Please Select
Please select course status
Course 1
Course - Section #
Course 2
Course - Section #
Course 3
Course - Section #
Course 4
Course - Section #
Course 5
Course - Section #
Are you enrolled in courses at a "Secondary Institution", and require a "Parent School Letter"?
Yes (Upload courses below)
No
"Secondary Institution"
Courses enrolled at "Secondary Institution"
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PLEASE READ
*
I authorize LAPU to certify my current enrollment with the VA.
It is my responsibility to notify the LAPU Military and Veterans Benefits Office when I drop, add, or withdraw from ANY of the classes certified towards my VA education Benefits. Federal law requires any changes in enrollment status that may affect VA education benefits be reported. Any changes to your class schedule (i.e. adds/drops) may have an impact on your VA education benefits.
GI Bill® BAH enrollment. Any eligible GI Bill®l BAH or stipends will be paid for the enrollment period of each class that I am attending. I must be enrolled above 1/2 time to receive any BAH payments from the VA. Call 1-888-GI-Bill-1 (1-888-442-4551) to speak with a GI Bill® representative.
Forever GI Bill® Housing allowance. “Forever GI Bill (FGIB),” Section 107 of the law requires the VA to calculate monthly housing payments based on the location of the campus where a student attends the majority of their classes. If you are a student Veteran, please keep in mind your campus's zip code may affect your payment amount.
I acknowledge that I am responsible for any balances on my account that my benefits will not cover.
Federal law requires any changes in enrollment status that may affect VA education benefits be reported. Any changes to your class schedule (i.e. adds/drops) may have an impact on your VA education benefits.
I have read and agree to all statements above
*
Signature
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