Form 22-1999 VA Enrollment Certification

OMB Control No. 2900-0073
Respondent Burden: 10 Minutes
Expiration Date: XX/XX/XXXX

INSTRUCTIONS AND CERTIFICATIONS FOR
VA ENROLLMENT CERTIFICATION (VA FORM 22-1999)
IMPORTANT: Use Side A for Institutions of Higher Learning (IHL) or schools providing non-college degree (NCD)
training. Use Side B for flight, correspondence, and apprenticeship or on-the-job training programs. Use the VA-ONCE (VA
Online Certification) application to file this information electronically. Contact your Education Liaison Representative (ELR)
for assistance.
Read the Certifications below before completing EITHER Items 19D and 19E on Side A OR Items 12D and 12E on Side
B. COMPLETE ONLY ONE SIDE OF THIS FORM. If completing Side B, pull out the carbon and reverse before
completing that side. Ensure that VA Copy 1 is on top.
IT IS HEREBY CERTIFIED THAT:

CERTIFICATIONS

(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.);
(7) Check "Yes," if the student is a Yellow Ribbon Program participant;
(8) FOR ENROLLMENTS UNDER CHAPTERS 30, 32, 33, 1606, and 1607: All the 85-15 ratio requirements have been satisfied.

INSTITUTIONS OF HIGHER LEARNING OR SCHOOLS PROVIDING NON-COLLEGE DEGREE TRAINING
IT IS HEREBY CERTIFIED THAT:
(9) FOR ENROLLMENTS REQUESTING ADVANCE PAYMENT: It is agreed that 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;
(10) IF CERTIFYING "GUEST STUDENT", place the name of the primary institution in Item 17, "Remarks";
(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.
(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.

FLIGHT TRAINING

IT IS HEREBY CERTIFIED THAT:
(13) The student has a Private Pilot's Certificate. I certify that a copy of the student's Class II Medical Certificate as of the beginning date of
the course is on file at this institution. If the student is enrolled in an Airline Transport Pilot course, I certify that a copy of the student's
valid Class I Medical Certificate as of the beginning date of the course is on file at this institution. For all initial enrollment certifications, I
have placed the name and date of the medical certificate in Item 11, "Remarks" on Side B.

APPRENTICESHIP AND OTHER OJT PROGRAMS

IT IS HEREBY CERTIFIED THAT:
(14) The employer will immediately notify VA once the trainee receives the journeyman wage. Exceptions to this rule include training on a
Davis-Bacon job, or a job in a geographic location with a different wage scale.

SPECIAL INSTRUCTIONS
ADVANCE PAYMENT INFORMATION - 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.

ACCELERATED PAYMENT INFORMATION - 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.
VA FORM
XXX XXXX

22-1999

SUPERSEDES VA FORM 22-1999, JUN 2011,
WHICH WILL NOT BE USED.

Privacy Act Notice: 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., VA sends educational forms or letters with a
veteran's identifying information to the veteran's school or training establishment to (1) assist the veteran in the completion of claims
forms or (2) VA obtains further information as may be necessary from the school for VA to properly process the veteran's education
claim or to monitor his or her progress during training) as identified in the VA system of records, 58VA21/22/28, Compensation,
Pension, Education and Vocational Rehabilitation and Employment Records - VA, and published in the Federal Register. Your obligation
to respond is required to obtain or retain benefits. While you do not have to respond, VA cannot pay the student any further education
benefits until we receive the information. We cannot pay the student any education benefits until we receive this information (38 U.S.C.
3684). Your responses are 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 the student's eligibility for education benefits and the proper amount payable.
Title 38, United States Code, allows us to ask for this information. We cannot pay the student any education benefits until we receive this
information which schools are required to submit (38 U.S.C. 3684). 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 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 1-888GI-BILL-1 (1-888-442-4551) to get information on where to send comments or suggestions about this form.

VA FORM 22-1999, XXX XXXX

NOTE: Tear off and read the Instruction and Certification Sheet before completing the form.

OMB Control No. 2900-0073
Respondent Burden: 10 Minutes
Expiration Date: XX/XX/XXXX

Side

A

VA ENROLLMENT CERTIFICATION
IMPORTANT: Side A is for Institutions of Higher Learning or schools offering non-degree training.

1. NAME OF STUDENT (First, Middle, Last)

2. VA FILE NO. (For chapter 35, include suffix. For Transferability

3. CURRENT ADDRESS OF STUDENT

4. SOCIAL SECURITY NUMBER OF STUDENT (If not entered in

5. TYPE OF TRAINING

6A. NAME OF PROGRAM

cases, enter the veteran's social security number)

Item 2)

UNDERGRADUATE COLLEGE DEGREE

FARM COOPERATIVE

GRADUATE OR ADVANCED
PROFESSIONAL

HIGH SCHOOL

6B. IS STUDENT MATRICULATED AT YOUR FACILITY? (For VA

purposes, a student is matriculated when formally admitted as
a degree seeking student)

COOPERATIVE (Not Farm)

NON-COLLEGE DEGREE

YES

NO

6C. IS PARENT SCHOOL LETTER ON FILE?
YES
NO

GUEST STUDENT

(Supplemental School)
(Complete Item 6C)

7. YELLOW RIBBON RECIPIENT
YES

NO

ENROLLMENT DATA

8. ENROLLMENT EFFECTIVE
DATES

(Month, Day, Year)

B. END

A. BEGIN

9. COURSES TAKEN
CREDIT HOUR COURSE(S) NON-CREDIT 10. CLOCK
HOURS
TAKEN BY
REMEDIAL/
TAKEN
DISTANCE DEFICIENCY/ PER WEEK
IN-RESIDENCE LEARNING REFRESHER
A. HOURS
HOURS
B. HOURS
C. HOURS

11. CHARGES
FOR PERIODS
OF INSTRUCTION
TUITION AND FEES

12. YELLOW
RIBBON
PROGRAM
A. AMOUNT

B. OUT OF STATE
CHARGES

13. TRAINING
TIME

(Graduate or
Advanced
Professional
Program)

14. ADDITIONAL INFORMATION FOR HIGH SCHOOL AND FARM CO-OP COURSES
B. FARM CO-OP ONLY (Is student pursuing course concurrently with substantially
school units for which the student is enrolled)
full-time agricultural employment averaging at least 40 hours per week?)

A. HIGH SCHOOLS APPROVED ON A UNIT BASIS (Enter the number of high

YES

NO

ADVANCE PAYMENT REQUEST - (Note: Advance payment is not accelerated payment.) (See Special Instructions.)
I REQUEST AN
ADVANCE PAYMENT

15A. SIGNATURE OF STUDENT

15B. DATE SIGNED

ACCELERATED PAYMENT REQUEST
(Note: Accelerated payment is not advance payment.) (See Special Instructions.)

I am requesting an accelerated payment under either chapter 30, 1606, or 1607. If I am requesting payment under chapter 30, I certify I intend to seek employment in one of the
following industries: Biotechnology, Life Science Technologies, Opto-electronics, Computers and Telecommunications, Electronics, Computer-integrated Manufacturing, Material
Design, Aerospace, Weapons, or Nuclear Technology.
16A. SIGNATURE OF STUDENT
16B. DATE SIGNED

I REQUEST AN
ACCELERATED PAYMENT
(All Chapters)

17. REMARKS

NOTE - 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 if course(s) are taken at a branch or extension of a school as defined in 38 CFR 21.4266(c).

18. NAME AND ADDRESS OF CONTRACT SCHOOL OR BRANCH LOCATION

CERTIFICATIONS - The provisions described in paragraphs (1) through (14) on the attached sheet are certified.

19A. FACILITY CODE

19B. SCHOOL NAME AND ADDRESS

19C. TELEPHONE NUMBER OF CERTIFYING OFFICIAL

19D. SIGNATURE OF CERTIFYING OFFICIAL

VA FORM
XXX XXXX

22-1999

SUPERSEDES VA FORM 22-1999, JUN 2011,
WHICH WILL NOT BE USED.

19E. DATE SIGNED

OMB Control No. 2900-0073
Respondent Burden: 10 Minutes
Expiration Date: XX/XX/XXXX

NOTE: Tear off the Instructions and Certifications sheet before completing the form.

Side

B

VA ENROLLMENT CERTIFICATION
IMPORTANT: Side B is for flight, correspondence, and apprenticeship or on-the-job training programs.

1. NAME OF STUDENT (First, Middle, Last)

2. VA FILE NO. (For chapter 35, include suffix. For transferability

3. CURRENT ADDRESS OF STUDENT

4. SOCIAL SECURITY NUMBER OF STUDENT (If not entered in

cases, enter the veteran's social security number)

Item 2)

5. NAME OF PROGRAM

7. CREDIT FOR PREVIOUS TRAINING (Not Flight)

6. TYPE OF TRAINING
FLIGHT TRAINING
CORRESPONDENCE
APPRENTICESHIP OR OTHER ON-THE-JOB

VOCATIONAL FLIGHT TRAINING (See Instructions)
8A. CREDIT ALLOWED FOR PREVIOUS EDUCATION AND TRAINING
DUAL

SOLO

GROUND SCHOOL

8B. DATE TRAINING BEGAN
IN CURRENT COURSE

CERTIFICATES AND RATINGS

8C. NUMBER OF HOURS/UNITS OF INSTRUCTION IN CURRENT COURSE
DUAL

SOLO

GROUND SCHOOL

PRE- AND POST
FLIGHT

8D. TOTAL CHARGES

OTHER

$
CORRESPONDENCE TRAINING
IMPORTANT: A VA Form 22-1999c, Certificate of Affirmation of Enrollment Agreement, MUST be signed by this student
and accompany this certification form before VA can authorize payment for this correspondence course.
9A. DATE FIRST LESSON
SENT TO STUDENT

9B. NUMBER OF LESSONS FOR
WHICH STUDENT IS ENROLLED

9C. CHARGE PER LESSON TO
STUDENT

9D. WERE ANY LESSONS SERVICED BEFORE THE
DATE ENTERED IN ITEM 9A?
YES

NO

(If "Yes," show lesson number and
date serviced in Item 11, "Remarks")

APPRENTICESHIP AND OTHER ON-THE-JOB TRAINING
IMPORTANT: A signed copy of the training agreement outlining the training program and wage scale as approved by the State
Approving agency or VA, or for apprentices, any document signed by the trainee incorporating this agreement by reference must be
attached to this form. (Show monthly number of hours worked to date in Item 11, "Remarks.")
10A. TRAINING DATES

10B. TYPE OF TRAINING

(Month, Day, Year)

BEGINNING

ENDING

10C. NUMBER OF HOURS
TRAINEE IS EMPLOYED PER WEEK
IN TRAINING PROGRAM

10D. NUMBER OF HOURS IN
STANDARD WORK WEEK

APPRENTICESHIP

HRS.

HRS.

OTHER-ON-THE-JOB

HRS.
HRS.

HRS.
HRS.

11. REMARKS

CERTIFICATIONS - The provisions described in paragraphs (1) through (14) on the attached sheet are certified.

12A. FACILITY CODE

12B. SCHOOL NAME AND ADDRESS

12C. TELEPHONE NUMBER OF CERTIFYING OFFICIAL

12D. SIGNATURE OF CERTIFYING OFFICIAL

VA FORM
XXX XXXX

22-1999

SUPERSEDES VA FORM 22-1999, JUN 2011,
WHICH WILL NOT BE USED.

12E. DATE SIGNED