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Click ‘Get Form’ to open it in the editor.
Begin by entering the student's name in Item 1. Ensure that you provide the full name as required.
In Item 2, input the VA File Number. If applicable, include the suffix for Chapter 35 benefits or the veteran's Social Security Number for transferability cases.
Complete Item 3 with the current address of the student to ensure accurate communication.
For Item 4, enter the Social Security Number of the applicant if not already provided in Item 2.
In Item 5, specify the dates of the term affected by entering both begin and end dates.
Fill out Item 6A with the last date of attendance using appropriate methods such as attendance records or grading reports.
Select a reason for termination in Item 6B by checking the appropriate box based on circumstances surrounding withdrawal or adjustment.
Continue filling out Items 7 through 12 as necessary, providing detailed information about adjustments and any remarks needed for clarification.
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IMPORTANT: A VA Form 22-1999c, Certificate of Affirmation of Enrollment Agreement, MUST be signed by this student and accompany this certification form beforeRead more
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