Form VA Form 21-8926 VA Form 21-8926 Certification of School Attendance - REPS

OMB Control No. 2900-0394
Respondent Burden: 15 Minutes
Expiration Date: XXXXXXX

CERTIFICATION OF SCHOOL ATTENDANCE - REPS
IMPORTANT: The certification is requested on behalf of the student named below to determine entitlement to benefits. While you are not required to respond,
your cooperation in promptly completing and returning this form will be appreciated. The form should be returned to the VA Regional Office (21Q), 400
South 18th Street, St. Louis, MO 63103.

.

1. NAME AND ADDRESS OF SCHOOL

PRIVACY ACT NOTICE : The VA will not disclose information
collected on this form to any source other than what has been
authorized under the Privacy Act of 1974 or Title 38, CFR 1.576 for
routine uses (i.e., civil or criminal law enforcement, congressional
communications, epidemiological or research studies, the collection of
money owed to the United States, litigation in which the United States
is a party or has an interest, the administration of VA programs and
delivery of VA benefits, verification of identity and status, and
personnel administration) as identified in the VA system of records,
58VA21/22/28, Compensation, Pension, Education, and Vocational
Rehabilitation and Employment Records - VA, published in the Federal
Register. Your obligation to respond is required to obtain or retain
benefits. The requested information is considered relevant and
necessary to determine maximum benefits under the law. The responses
you submit are considered confidential (38 U.S.C. 5701). Information
submitted is subject to verification through computer matching
programs with other agencies.

NOTE - REPS represents the Restored Entitlement Program For Services.
2. VETERAN'S/WAGE EARNER'S SOCIAL
SECURITY NUMBER

4. STUDENT'S SOCIAL SECURITY NUMBER

3. STUDENT'S NAME

COMPLETE ALL ITEMS BELOW
GIVING INFORMATION ONLY
FOR THE PERIOD INDICATED

5. ATTENDANCE
A. FROM (Month, day, year)

►

B. TO (Month, day, year)

STUDENT CERTIFICATION
6E. DATES OF FULL-TIME ATTENDANCE INDICATED IN ITEM 6D

6. DURING THE PERIOD SHOWN IN ITEM 5:
D.
I ATTENDED FULLA.
I AM ATTENDING FULL-TIME
TIME ONLY FOR THE
B.
I AM NOT ATTENDING FULL-TIME PERIOD INDICATED IN
ITEM 6E (Provide dates of
C.
I DID NOT ATTEND
full-time attendance)

FROM (Month, day, year)

TO (Month, day, year)

I CERTIFY THAT the foregoing statement is true and correct to the best of my knowledge and belief.
7A. SIGNATURE OF STUDENT

7B. DATE

CERTIFICATION BY SCHOOL OFFICAIL

8. IS THE STUDENT ENROLLED IN FULL-TIME STATUS ACCORDING TO THE SCHOOL'S STANDARDS AND PRACTICES FOR THE PERIOD SHOWN IN ITEM 5?
(For evening students, use the same standards applicable to day students)
YES

NO

(If "No," complete Item 9)

9. ENTER BEGINNING AND ENDING DATES (UP TO THE PRESENT) OF STUDENT'S
FULL-TIME STATUS (If none, enter "NONE") (If more space is needed, enter additional
information in Item 12, Remarks, and key answers to item numbers)

A. FROM (Month, day, year)

B. TO (Month, day, year)

►

10. TYPE OF SCHOOL
JUNIOR COLLEGE, COLLEGE OR
UNIVERSITY UNDERGRADUATE

COLLEGE GRADUATE

COMPLETE ALL ITEMS BELOW
GIVING INFORMATION ONLY
FOR THE PERIOD INDICATED

►

TECHNICAL, TRADE
OR VOCATIONAL

OTHER
(Specify)

11. ENTER THE TOTAL CLOCK HOURS PER WEEK THE STUDENT IS/WAS SCHEDULED
TO ATTEND (Show any variation in scheduled attendance in Item 12, Remarks, and key
answers to item numbers)

12. REMARKS

RESPONDENT BURDEN: This information is needed to help determine a surviving spouse's qualifications for a VA guaranteed home loan. Title 38, USC, Section 3702 authorizes collection
of this information. We estimate that you will need an average of 15 minutes to review the instructions, find the information and complete this form. VA cannot conduct or sponsor a collection
of information unless a valid OMB control number is displayed. You are not required to respond to a collection of information if this number is not displayed. Valid OMB control numbers can
be located on the OMB Internet Page at www.reginfo.gov/public/do/PRAMain. If desired, you can call 1-800-827-1000 to get information on where to send comments or suggestions about this
form.

I CERTIFY THAT the foregoing statement is true and correct to the best of my knowledge and belief.
13A. SIGNATURE AND TITLE OF SCHOOL OFFICAIL

VA FORM
XXX 2014

21-8926

13B. SCHOOL TELEPHONE NO.
(Include Area Code)

SUPERSEDES VA FORM 21-8926, JUL 2011,
WHICH WILL NOT BE USED.

13C. DATE