Va Form 22 1999 – Fill Out and Use This PDF

1. Name of Student: enter First, Middle, Last.

2. VA File No.: for chapter 35, include suffix. For Transferability cases, enter the veteran's social security number.

Enter the Current Address of Student in 3.

If not entered in Item 2, enter the Social Security Number of Student in 4.

5. Type of Training has these boxes: Undergraduate College Degree, Farm Cooperative, High School, Graduate or Advanced Professional, Non-College Degree, Cooperative (Not Farm) and Guest Student (Supplemental School).

For Guest Student, complete Item 6. C. (10) If certifying Guest Student, place the name of the primary institution in Item 17, Remarks.

Enter the Name of Program in 6. A.

6. B. Is Student Matriculated at Your Facility? For VA purposes, a student is matriculated when formally admitted as a degree seeking student. Check YES or NO.

6. C. Is Parent School Letter on File? Check YES or NO.

7. Yellow Ribbon Recipient: check Yes if the student is a Yellow Ribbon Program participant.

8. A. Location(s) Zip Code: the Zip Code entered is the Zip Code associated with the course hours as reported in this block where the student is physically participating in the course or courses certified.

Enter the Begin and End of the Enrollment Effective Dates in 8. B. as Month, Day, Year.

9. Courses Taken has A. Hours Taken In-Residence, B. Hours Taken by Distance Learning and C. Hours Remedial/ Deficiency/ Refresher.

Enter the Clock Hours per Week in 10.

(11) For noncredit deficiency, remedial, or refresher courses, the courses certified in Item 9B are needed by the student in order to pursue a program of education at this institution.

Enter the Charges for Periods of Instruction in 11: Tuition and Fees.

(12) Yellow Ribbon Program: if applicable, enter the amount of Yellow Ribbon Program contributions your institution is making on behalf of the student for each term, quarter, or semester. If the Yellow Ribbon Program will be used to cover all or a portion of any out of State charges, enter the net total out of State charges assessed the student.

13. Training Time is for the Graduate or Advanced Professional Program.

14. Additional Information for High School and Farm Co-Op Courses.

For High Schools Approved on a Unit Basis, enter the number of high school units for which the student is enrolled.

B. Farm Co-Op Only: Is student pursuing course concurrently with substantially full-time agricultural employment averaging at least 40 hours per week? Check YES or NO.

Veterans and other claimants must complete Items 15A and 15B on Side A to request an advance payment of education benefits. Upon receipt of a timely request and enrollment information, VA will pay the veteran or claimant an advance payment of his or her education benefits. An advance payment is part of the first month and the second month's education benefits. VA will send the payment to the veteran's school for delivery to the veteran or other claimant upon entry into training.

Advance payment is not accelerated payment.

15. A. Signature of Student (Sign in ink) and 15. B. Date Signed.

Claimants must complete Items 16A and 16B on Side A to request an accelerated payment. Chapter 30, 1606, and 1607 beneficiaries (or beneficiaries receiving transfer-of-entitlement benefits under these chapters) qualify for an accelerated payment. An accelerated payment can only be paid under chapter 30 to claimants in a high technology program. (A list of programs is on the Internet at "www.gibill.va.gov".) An accelerated payment can only be paid under chapters 1606 or 1607 for claimants pursuing a program to qualify for accelerated payment, the cost of the program must exceed twice the amount of education benefits otherwise payable for that training.

Accelerated payment is not advance payment.

16. A. Signature of Student (Sign in ink) and 16. B. Date Signed.

(9) For enrollments requesting advance payment, the initial check for this enrollment period will be mailed to the school for temporary care and delivery to the student upon registration but not more than 30 days before the commencement of training. It is understood that the completion of a certificate of delivery will normally be required upon delivery of the advance payment.

Enter Remarks in 17.

Complete Item 18 only if course(s) are contracted out to another school or are given at a branch location other than shown in Item 19B.

Do not complete Item 18, Name and Address of Contract School or Branch Location, if course(s) are taken at a branch or extension of a school as defined in 38 CFR 21.4266(c).

Read the Certifications before completing either Items 19D and 19E on Side A or Items 12D and 12E on Side B.

Certifications: the provisions described in paragraphs (1) through (14) on the attached sheet are certified.

Enter the Facility Code in 19. A., the School Name and Address in 19. B. and the Telephone Number of Certifying Official in 19. C.

19. D. Signature of Certifying Official (Sign in ink) and 19. E. Date Signed.

(1) This institution has exercised reasonable diligence in meeting all applicable requirements of Title 38, U.S. Code, and any failure by the institution to meet any requirements of the law will be reported promptly to VA.

(2) The course or courses certified are approved by the State Approving agency and are generally acceptable to meet requirements for the student's educational, professional, or vocational objective.

(3) No course certified is a repetition of any course previously satisfactorily completed except as permitted by VA regulations.

(4) This institution holds no power of attorney agreement authorizing the institution to negotiate VA educational assistance allowance checks.

(5) For privately owned schools: the student certified is not an owner or officer of the school nor is the student certified as an official authorized to sign enrollment certifications.

(6) This institution agrees to report promptly to VA any enrollment change and any change due to unsatisfactory progress, conduct, or attendance. Promptly means within 30 days of the enrollment change. (Except for students receiving benefits under chapter 33, the institution need not report an enrollment change for a student who was in full-time attendance before the change and in full-time attendance after the enrollment change.)

For enrollments under chapters 30, 32, 33, 1606, and 1607: all the 85-15 ratio requirements have been satisfied.

VA Form 22-1999 is the VA Enrollment Certification, with Side A for schools and Side B for training programs. Tear off and read the Instruction and Certification Sheet before completing the form.

Use the VA-ONCE (VA Online Certification) application to file this information electronically.