Form 22-1999b Notice of Change in Student Status

Notice of Change in Student Status (VA Form 22-1999b)

VA Form 22-1999b (508 Conformant 2-13-18 - OMB Expiring 3-31-18)

Notice of Change in Student Status

OMB: 2900-0156

⚠️ Notice: This form may be outdated. More recent filings and information on OMB 2900-0156 can be found here:

Document [pdf]

Download: pdf | pdf

INSTRUCTIONS FOR NOTICE OF CHANGE IN STUDENT STATUS
NOTE: All items not mentioned are considered self-explanatory.
Item 2 - Enter the VA FILE NUMBER: This is usually the veteran's
claim number or social security number.
Item 2 - If the claimant is receiving CHAPTER 35 benefits, enter his or
her suffix. (This is a letter (A, B, etc.) designation.) For transferability
cases, enter the veteran's social security number.
Item 4 - If the claimant is receiving benefits transferred to him or her,
enter the claimant's SOCIAL SECURITY NUMBER.
Items 5A and 5B - DATES OF TERM AFFECTED: Enter the begin and
end dates for the term in which the change in student status occurred.
Item 5C - LOCATION ZIP CODE: Enter the zip code associated with
the term in which the change in student status occurred.
Item 6A - LAST DATE OF ATTENDANCE: Enter the actual last
date of attendance. For college level courses, you may use one of the
following methods to determine the last date of attendance: (1)
attendance records; (2) grading reports; (3) last date on which
examination or other papers filed; (4) last day of activity in the
instructor's records; or (5) a statement from the student as to the last day
of his or her attendance
Item 6B - REASON FOR TERMINATION: (Check the appropriate
box.)
WITHDRAWAL DURING DROP PERIOD: Check this box for
withdrawals during an officially designated drop period of not more than
30 days. Do not use this box for withdrawals after the drop period of
more than 30 days after the start of the term, whichever is earlier.
WITHDRAWAL AFTER DROP PERIOD - NONPUNITIVE GRADE
ASSIGNED: A nonpunitive grade is any grade not used to compute
graduation requirements. A nonpunitive grade is the equivalent of an
audited course for purposes of advancement toward graduation. Typical
examples are "W" (withdrawal) and "NC" (no credit). Complete Item 9
& 11.
WITHDRAWAL AFTER DROP PERIOD - PUNITIVE GRADE
ASSIGNED: A punitive grade is one assigned a value when computing
graduation requirements. A common example is an "F" (failing) grade
which has a quality point value of "zero."
UNSATISFACTORY ATTENDANCE, CONDUCT, OR PROGRESS:
Check this box for failure to meet the school's standards of attendance,
conduct, or progress. In Item 6A, show the last date attendance, conduct,
or progress was satisfactory.
OTHER (Explain in Item 12, Remarks): Check this box for any
termination reason not shown.
WITHDRAWAL OR INTERRUPTION (Noncollege Degree Programs
(NCD)): "Noncollege Degree Programs" refers to programs such as
diploma or certificate programs that do not lead to a standard college
degree. Check this box if a student terminates or interrupts a noncollege
degree program that is not offered on a term, quarter, or semester basis.
(The program may be offered on a block, unit, or clock basis.) For
such programs, report in Item 12, Remarks, the first date from which no
credit accrued toward graduation.
If the nondegree program is offered on a term, quarter, or semester basis,
check the most appropriate of the remaining boxes.
Item 6C - LAST DATE CREDIT ACCRUED (For NCD Only): For
NCD programs operating on a block, unit, or clock basis, enter the last
date the student accrued credit toward graduation.
Item 7B - TYPE OF ADJUSTMENT:
INCREASE: Check this box to show an increase in credit hours, clock
hours, or high school units.
REDUCTION DURING DROP PERIOD: Check this box for reductions
during an officially designated drop-add period of not more than 30 days.
REDUCTION AFTER DROP PERIOD - NONPUNITIVE GRADE
ASSIGNED: See Instruction Item 6B for a definition of "nonpunitive."
Complete Items 9 & 11.
REDUCTION AFTER DROP-ADD PERIOD - PUNITIVE GRADE
ASSIGNED: See Instructions Item 6B for a definition of "punitive."
VA FORM 22-1999b, XXXX

STUDENT COMPLETED TERM BUT NONPUNITIVE GRADES
ASSIGNED FOR ONE OR MORE COURSES: Check this box if a
student completed a term but received nonpunitive grades for one or
more courses. EXAMPLE: A student completes 12 credits and
receives "W" grades for 6 credits. Enter the last day of the term in Item
7A. Enter 12 in Item 7C and 6 in Item 7D.
REDUCTION (Noncollege Degree Programs) "Noncollege Degree
Programs": refers to programs such as diploma or certificate
programs that do not lead to a standard college degree. Check this box
if a student reduces his or her course load in a noncollege degree
program that is not offered on a term, quarter, or semester basis. (The
program may be offered on a block, unit, or clock basis.) For such
programs, report in Item 12, Remarks, the first date from which no
credit accrued toward graduation.
If the nondegree program is offered on a term, quarter, or semester
basis, do not check this box. Check the most appropriate of the
remaining boxes.
OTHER (Explain in Item 12 Remarks): Check this box for any
adjustment type not shown. EXAMPLES: (a) Incomplete "I" grade(s)
not converted to credit grade(s) within one calendar year, or (b)
Incomplete "I" grade converted to credit grade(s) or to punitive, failing
grade(s).
Items 7C and 7D - CREDIT HOURS: Show a breakdown of credit
hours as shown on VA Form 22-1999, Enrollment Certification, if
necessary. If the student is taking noncredit, remedial, deficiency, or
independent study courses, show these hours in addition to the credit
hours.
EXAMPLE:
Before Adjustment
After Adjustment
6 credit hours
3 credit hours
+
+
3 deficiency hours
3 deficiency hours
Item 8 - CHARGES FOR PERIOD OF ENROLLMENT: When
required report the customer charges for the ADJUSTED load only.
EXAMPLE: A student starts a term at full time, but reduces to less
than half-time in the third week.
Item 9 - PREVIOUS CERTIFICATIONS FOR SUBSEQUENT
TERMS: Check "yes" if there are terms, previously certified, which
follow the term of the termination or adjustment and are not affected
by the termination or adjustment. Check "no" if there are terms,
previously certified, which follow the term of the termination or
adjustment and are no longer valid.
Item 10 - CALLUP TO ACTIVE DUTY: If the termination or
adjustment occurs because the student has been called to active duty,
please indicate whether credit has been granted for interrupted
coursework by checking the appropriate box.
Item 11 - MITIGATING CIRCUMSTANCES: These are unavoidable or unexpected events that directly interfere with a student's pursuit
of a course and are beyond the student's control. Students must submit
corroborative evidence to substantiate their reasons for being unable to
complete a course or courses, or receiving a nonpunitive grade.
Item 12 - REMARKS: Use this space to provide any needed
clarification. It is important to clarify the student's status for terms
after the one in which a change occurred. EXAMPLE: A student
certified for the entire school year withdraws during the fall term. If
the student is still enrolled for the spring term, enter that information in
Item 12, "Remarks."
Item 13C - NAME AND ADDRESS OF SCHOOL OR TRAINING
ESTABLISHMENT (Include facility code): Enter the complete name
and address of the school or training establishment and the facility
code. Facility codes contain 8 numbers which identify a particular
school or training establishment. If you do not know your facility
code, contact the VA Education Liaison Representative. Entering the
facility code will help VA to be sure that your school is properly
shown in the student's record.

PRIVACY ACT INFORMATION: 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., award of benefits) as identified in the VA system of records, 58VA21/22,
Compensation, Pension, Education and Vocational Rehabilitation and Employment Records - VA, published in the Federal Register. Your obligation to
respond is required to obtain benefits. We cannot pay the student any further education benefits until we receive this information (38 U.S.C 3684).
Information submitted is subject to verification through computer matching programs with other agencies.
RESPONDENT BURDEN: We need this information to determine whether educational benefits should be increased, decreased, or terminated, and if
so, the effective date of such change (38 U.S.C. 3034(a), 3241, 3474, 3524, 3680(a), and 10 U.S.C. 510, 1636(b), and chapter 1607). Title 38, U.S.C.,
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 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 1-888-GI-BILL-1 (1-888-442-4551), (Telecommunications Device for the Deaf
(TDD), Federal Relay number is 711), to get information on where to send your comments or suggestions about this form.

VA FORM 22-1999b, XXXX

OMB Approved No. 2900-0156
Respondent Burden: 10 Minutes
Expiration Date: XXXXXXXX

NOTICE OF CHANGE IN STUDENT STATUS
1. NAME OF STUDENT (First, Middle, Last)

2. VA FILE NO. (For chapter 35, include suffix. For transferability
cases, enter the veteran's Social Security Number)

3. CURRENT ADDRESS OF STUDENT

4. SOCIAL SECURITY NO. OF APPLICANT (If not entered in
Item 2 above)

5. DATES OF TERM AFFECTED
A. BEGIN DATE

B. END DATE

C. LOCATION ZIP CODE

6. TERMINATION (Complete Items A and B, and C if applicable)
A. LAST DATE OF
ATTENDANCE

B. REASON FOR TERMINATION

END OF TERM OR COURSE

WITHDRAWAL BEFORE BEGINNING OF TERM

UNSATISFACTORY ATTENDANCE, CONDUCT, OR PROGRESS

WITHDRAWAL DURING DROP PERIOD

GRADUATION

WITHDRAWAL AFTER DROP PERIOD - NONPUNITIVE
GRADES ASSIGNED (If checked, complete Item 9 & 11)
WITHDRAWAL AFTER DROP PERIOD - PUNITIVE
GRADES ASSIGNED

WITHDRAWAL OR INTERRUPTION (Noncollege Degree Programs
not on term basis- see Instructions)
OTHER (Explain in Item 12, Remarks)

C. LAST DATE CREDIT ACCRUED (For non-college degree courses only)

7. ADJUSTMENT OF CREDIT OR CLOCK HOURS (Complete Items A, B, and C thru H as applicable)
A. DATE ADJUSTMENT
IS EFFECTIVE

B. TYPE OF ADJUSTMENT
INCREASE

REDUCTION AFTER DROP PERIOD - PUNITIVE GRADES ASSIGNED

INCREASE ON FIRST DAY OF TERM

STUDENT COMPLETED TERM, BUT NONPUNITIVE GRADES ASSIGNED
FOR ONE OR MORE COURSES (If checked, complete Item 8)

REDUCTION ON FIRST DAY OF TERM

REDUCTION (Noncollege Degree Programs not on term basis- see Instructions)

REDUCTION DURING DROP PERIOD
REDUCTION AFTER DROP PERIOD - NONPUNITIVE
GRADES ASSIGNED (If checked, complete Item 9 & 11)
C. CREDIT HOURS BEFORE ADJUSTMENT

D. CREDIT HOURS AFTER ADJUSTMENT

F. CLOCK HOURS OR HIGH SCHOOL UNITS BEFORE
ADJUSTMENT

E. TRAINING TIME AFTER ADJUSTMENT (For graduate and advanced
professional)
FULL TIME

3/4 TIME

LESS THAN 1/2 TIME

1/4 TIME OR LESS

G. CLOCK HOURS OR HIGH SCHOOL UNITS AFTER
ADJUSTMENT

8. CHARGES FOR PERIOD OF ENROLLMENT (Complete this item for in-service
students, student's whose training load after adjustment is less than 1/2 time and all
chapter 33 students that have a change in status. List the charges for the adjusted load by
school year, term, or other period. This item does not apply to students receiving chapter
32 or 1606 benefits).

1/2 TIME

H. REVISED ENDING DATE

B. FEES

A. TUITION

9. DO PREVIOUS CERTIFICATIONS FOR SUBSEQUENT TERMS REMAIN UNCHANGED?
YES

OTHER (Explain in Item 9, Remarks)

C. YELLOW RIBBON
(Chapter 33 only)

10. CALLUP TO ACTIVE DUTY (Complete if student called to
active duty- see Instructions)
STUDENT CALLED UP - No Credit Granted
STUDENT CALLED UP - Credit Granted

11. MITIGATING CIRCUMSTANCES (Complete only if indicated by Item 6 or 7)
DOES THE STUDENT CLAIM THAT TERMINATION OR ADJUSTMENT ACTIONS INVOLVED MITIGATING CIRCUMSTANCES?
NO

YES

UNKNOWN

(If "Yes," attach student's statement together with the student's supporting evidence)

12. REMARKS

IT IS HEREBY CERTIFIED THAT the student's status changed on the date indicated and in accordance with the facts shown above.
13A. DATE

VA FORM
XXXX

13B. SIGNATURE AND TITLE OF CERTIFYING OFFICIAL (Sign in ink)

22-1999b

13C. NAME AND ADDRESS OF SCHOOL OR TRAINING ESTABLISHMENT
(Include Facility Code)

SUPERSEDES VA FORM 22-1999b, JUL 2012,
WHICH WILL NOT BE USED.

VA Copy 1