VA Form 22-1919 at a glance
What it is: The Conflicting Interests Certification for Proprietary Schools informs individuals that the law has restrictions concerning any potential conflict of interest (see certifications (1) and (2)).
Who signs: The president or chief administrative official of the school signs.
A filled-in VA Form 22-1919 example: a school president certifies that there is nothing to list
How to fill out VA Form 22-1919, box by box
Name and address of institution
Enter the name and address of the institution.
Proprietary profit schools only
In (1), for proprietary profit schools only, list the VA and SAA employees known to you who may have a potential conflict of interest under Title 38 U.S.C. 3683, which prohibits employees of the Department of Veterans Affairs (VA) and the State Approving Agency (SAA) from owning any interest in an educational institution operated for profit. The law prohibits these employees from receiving any wages, salary, dividends, profits or gifts from for-profit schools. In addition, the law prohibits VA employees from receiving any services from these schools. These provisions may be waived if VA determines that no detriment will result to the government, or to veterans or eligible persons. If there are none, enter the word "none."
Under NAME AND TITLE OF EMPLOYEES(S), enter the name and title, and under DESCRIPTION OF ASSOCIATION WITH SCHOOL, enter the description of association with the school.
All proprietary schools
In (2), for all proprietary schools (excludes public schools), list the names and VA file numbers (claim or Social Security Numbers) of any certifying officials, owners, or officers of your school who receive VA educational assistance based on an enrollment in your school. Title 38 C.F.R. 21.4202(c), 21.5200(c), 21.7122(e)(6), and 21.7622(f)(4)(iv) prohibit the payment of educational assistance to any veteran or eligible person based on an enrollment in any proprietary school of which the veteran or eligible person is an official authorized to sign certificates of enrollment or verifications/certifications of attendance, or is an owner or an officer. If there are none, enter the word "none."
Enter the name and title of the employee(s), the VA file number, and the dates of enrollment with your school (MM/DD/YYYY) from and to.
Certification and signature of the school
By signing, the entries are certified true and correct to the best of your knowledge, and you agree to immediately notify VA of any potential violations of the prohibitions.
Enter the name and signature in NAME AND SIGNATURE OF PRESIDENT OR CHIEF ADMINISTRATIVE OFFICIAL OF SCHOOL, the title in TITLE and the date in DATE SIGNED (MM/DD/YYYY).
Sources
[1] VA Form 22-1919 (MAR 2021), Conflicting Interests Certification for Proprietary Schools, Department of Veterans Affairs (the Official source link on this page).