VA Form 21-8960-1 Certification of School Attendance or Termination

File Number:

Name of Student:
Birth Date of Student:

Because we are paying Department of Veterans Affairs benefits based on your report that the student named above is
attending school, we ask that you verify the student's school attendance for this school year. Please answer the questions
below, sign and date the form, and return it within 60 days to the VA office address shown above. Otherwise, benefits
based upon the student's attendance will be discontinued.
OMB Control No. 2900-0458
Respondent Burden: 10 minutes
Expiration Date: XXXXXX

DEPARTMENT OF VETERANS AFFAIRS
CERTIFICATION OF SCHOOL ATTENDANCE OR TERMINATION
1. IS THE STUDENT NOW IN SCHOOL?
NO

YES

(If "No," do NOT complete Items 2 and 4.
Give the date and reason school attendance terminated)

2. HAS THE STUDENT ATTENDED SCHOOL FROM THE OFFICIAL BEGINNING OF THE SCHOOL YEAR? 3. IS THE STUDENT MARRIED? (If, "YES," give the date)
YES

NO

(If "No," enter the inclusive dates of
the student's school attendance)

4. NAME OF LAST SCHOOL ATTENDED

YES

NO

5. HAS THE STUDENT ATTENDED ANY OTHER SCHOOL 6. WHEN DOES THE STUDENT EXPECT TO GRADUATE OR
OTHERWISE TERMINATE THE COURSE OF STUDY? (Give
(S) THIS YEAR?
YES

date)

NO

7. HASTHE STUDENT BEGUN RECEIVING OR APPLIED FOR VA DEPENDENTS' EDUCATIONAL ASSISTANCE (DEA), FEDERAL EMPLOYEES' COMPENSATION ACT
PAYMENTS, OR BENEFITS FROM ANY OTHER FEDERAL AGENCY SUCH AS THE U.S. SERVICE ACADEMY, U.S. MERCHANT MARINE ACADEMY, BUREAU OF
INDIAN AFFAIRS, ETC., THAT IS OR WILL BEGIN TO PAY THE STUDENT'S TUITION?
(NOTE: Concurrent receipt of DEA benefits by the student and additional compensation payments based on that student's
YES
NO
school attendance is considered a duplication of benefits and is prohibited)

NOTE: The student should sign this form only if the student is receiving benefits in his or her own right. Otherwise, the parent, guardian, or custodian should sign in
Item 8 and enter his or her relationship to the student in Item 9.
I AGREE to notify the Department of Veterans Affairs immediately of any changes in this course of education, transfer to another school, discontinuance of school
attendance or marriage prior to completion of the course. I understand that continued entitlement to school attendance benefits may be based on the information I have
furnished on this form. Any benefits allowed due to this certification will be discontinued if the student marries or leaves school, or upon the death of the student.
I CERTIFY THAT the information provided is true and correct to the best of my knowledge and belief.

8. SIGNATURE

11. DAYTIME PHONE NUMBER (Include Area Code)

9. RELATIONSHIP TO STUDENT

12. EVENING PHONE NUMBER (Include Area Code)

10. DATE SIGNED
13. E-MAIL ADDRESS (If Applicable)

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, Code of Federal Regulations 1.576 for routine uses (i.e., civil or criminal law enforcement, congressional communications, epidemiological ore 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.
RESPONDENT BURDEN: We need this information to determine continued eligibility to benefits for a veteran's child who is over age 18 and attending school (38 U.S.C.). Title
38, United States Code, allows us to ask for this information. We estimate that you will need an average of 10 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 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.
PENALTY: The law provides severe penalties which include fine or imprisonment, or both, for the willful submission of any statement or evidence of a material fact,
knowing it to be false, or fraudulent acceptance of any payment to which you are not entitled.
VA FORM
XXX 2014

21-8960-1

SUPERSEDES VA FORM 21-8960-1, JUN 2011,
WHICH WILL NOT WILL BE USED.