22-1999 VA Enrollment Certification

OMB Control No. 2900-0073
Respondent Burden: 10 Minutes
Expiration Date: XXXXXXXX

INSTRUCTIONS AND CERTIFICATIONS FOR
VA ENROLLMENT CERTIFICATION (VA FORM 22-1999)

IMPORTANT: Use the VA-ONCE (VA Online Certification) application to file this information electronically. If you need
help completing this form, you may 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.
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: 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 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.
(13) STEM SCHOLARSHIP RECIPIENT: If "Yes" is checked, please provide the Classification of Instructional Programs (CIP) code of the
reported program in the "Remarks Section" Item 17. The CIP code is assigned by your school and reported to the Department of Education
annually. STEM is only available to Chapter 33 students who have or will soon exhaust their Chapter 33 entitlement. All STEM enrollment
certifications should be sent to the Buffalo Processing Office. (Please refer to the State of Jurisdiction Chart below for Buffalo RPO
mailing address.)

IT IS HEREBY CERTIFIED THAT:

FLIGHT TRAINING

(14) 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:
(15) 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 - The beneficiary must complete Items 15A and 15B on Side A to request an advance payment of
education benefits. Upon timely receipt of an advance pay request included with an enrollment certification, VA will pay the beneficiary an
advance payment of their benefits. An advance payment includes the first and second months' education benefits (of which the first
month may be prorated). VA will send the payment to the beneficiary's school for delivery to the beneficiary upon their entry into training.
ACCELERATED PAYMENT INFORMATION - Claimants must complete Items 16A and 16B on Side A to request an accelerated payment.
Chapter 30 and 1606 beneficiaries (or beneficiaries receiving transfer-of-entitlement benefits under these chapters) may qualify for an accelerated
payment. An accelerated payment can only be paid under chapter 30 to claimants enrolled in a high technology program. (A list of programs is on
the Internet at "www.gibill.va.gov".) Beneficiaries seeking an accelerated payment under chapter 1606 must be pursuing a high technology
program and the cost of that program must exceed twice the amount of education benefits otherwise payable for that training.
VA FORM
XXXX

22-1999

SUPERSEDES VA FORM 22-1999, JUN 2019,
WHICH WILL NOT BE USED.

Where to send this form (See exception for STEM Scholarship Recipients):
Step 1: Mail the completed form to the VA Regional Processing Office for the region of that school's physical address. See
below for the addresses of the VA Regional Processing Offices.
Step 2: The beneficiary will wait for VA to process this enrollment certification. The beneficiary will receive notice of our
decision. VA will notify the beneficiary if he or she is determined to not be eligible for education benefits.
Step 3: Exception for STEM Scholarship Recipients only: All enrollment certifications for STEM Scholars should
be sent to the Buffalo RPO address.
This enrollment certification can also be submitted online using VA-ONCE (VA Online Certification).

Eastern Region:
VA Regional Office
P.O. Box 4616
Buffalo, NY 14240-4616
SERVES THE FOLLOWING STATES
CO

CT

DC

DE

IA

IL

IN

KS

KY

MA

MD

ME

MI

MN

MO

MT

NC

ND

NE

NH

NJ

NY

OH

PA

RI

SD

TN

VA

VT

WI

WV

WY

APO/FPO AA

US VIRGIN ISLANDS

FOREIGN SCHOOLS

Western Region:
VA Regional Office
P.O. Box 8888
Muskogee, OK 74402-8888
SERVES THE FOLLOWING STATES
AK

AL

AR

AZ

CA

FL

GA

HI

ID

LA

MS

NM

NV

OK

OR

PR

SC

TX

UT

WA

APO/FPO AP

GUAM

PHILIPPINES

Privacy Act: 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 Veteran Readiness 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 education benefits until
we receive the 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
1-888-GI-BILL-1 (1-888-442-4551) to get information on where to send comments or suggestions about this form.
VA FORM 22-1999, XXXX

OMB Control No. 2900-0073
Respondent Burden: 10 Minutes
Expiration Date: XXXXXXX

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

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)
YES

COOPERATIVE (Not Farm)

NON-COLLEGE DEGREE

NO

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

GUEST STUDENT

(Supplemental School)
(Complete Item 6C)

7. YELLOW RIBBON RECIPIENT
YES

8. STEM SCHOLARSHIP RECIPIENT

NO

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 or 1606. 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
(Chapter 30 or 1606 only)

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 if applicable.

19A. FACILITY CODE

19B. SCHOOL NAME AND ADDRESS

19C. TELEPHONE NUMBER OF CERTIFYING OFFICIAL

19D. SIGNATURE OF CERTIFYING OFFICIAL

VA FORM
XXXX

22-1999

SUPERSEDES VA FORM 22-1999, JUN 2019,
WHICH WILL NOT BE USED.

19E. DATE SIGNED

SELECT COPY

OMB Control No. 2900-0073
Respondent Burden: 10 Minutes
Expiration Date: XXXXXXXX

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

APPRENTICESHIP AND ON-THE-JOB TRAINING
10A. TRAINING DATES

10B. TYPE OF TRAINING

(Month, Day, Year)

BEGINNING

ENDING

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

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

10D. NUMBER OF HOURS IN
STANDARD WORK WEEK

APPRENTICESHIP

HRS.

HRS.

ON-THE-JOB

HRS.
HRS.

HRS.
HRS.

11. REMARKS (You may show monthly number of hours worked to date here or use VA Form 22-6553d-1.)

CERTIFICATIONS - The provisions described in paragraphs (1) through (15) on the attached sheet are certified if applicable.

12A. FACILITY CODE

12B. SCHOOL NAME AND ADDRESS

12C. TELEPHONE NUMBER OF CERTIFYING OFFICIAL

12D. SIGNATURE OF CERTIFYING OFFICIAL (Sign in ink)

VA FORM
XXXX

22-1999

SUPERSEDES VA FORM 22-1999, JUN 2019,
WHICH WILL NOT BE USED.

12E. DATE SIGNED

SELECT COPY