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

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
designation. (This can be a letter such as A, B, etc. or a number such as 41, 42, etc.).
Item 4 - If the claimant is receiving benefits transferred to him or her, enter the
claimant's SOCIAL SECURITY NUMBER.
Item 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 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 - NON-PUNITIVE GRADE ASSIGNED:
A non-punitive grade is any grade not used to compute graduation requirements. A
non-punitive grade is the equivalent of an audited course for purposes of advancement
toward graduation. Typical examples are "W" (withdrawal) and "NC" (no credit).
Complete Items 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 (Non-college Degree Programs (NCD):
"Non-college 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 non-college 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 non-degree 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 - NON-PUNITIVE GRADE ASSIGNED:
See Instruction Item 6B for a definition of "non-punitive." Complete Items 9 & 11.
REDUCTION AFTER DROP-ADD PERIOD - PUNITIVE GRADE ASSIGNED:
See Instructions Item 6B for a definition of "punitive."
STUDENT COMPLETED TERM BUT NON-PUNITIVE GRADES ASSIGNED
FOR ONE OR MORE COURSES: Check this box if a student completed a term but
received non-punitive grades for one or more courses. EXAMPLE: A student
completed 12 credits and received "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.
STUDENT COMPLETED TERM BUT NON-PUNITIVE GRADES ASSIGNED
FOR ONE OR MORE COURSES: Check this box if a student completed a term but
received non-punitive grades for one or more courses. EXAMPLE: A student
completed 12 credits and received "W" grades for 6 credits. Enter the last day of the
term in Item 7A. Enter 12 in Item 7C and 6 in 7D.
VA FORM
XXX XXXX

22-1999b

REDUCTION (Non-college Degree Programs) "Non-college 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 non-college 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 non-degree 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 deficiency hours

3 credit hours
+
3 deficiency hours

Item 8 - CHARGES FOR PERIOD OF ENROLLMENT: When required, report
the student's charges for the ADJUSTED load as if the
student began at the adjusted load.
EXAMPLE: A student starts a term at 12 credits at $1,000 but reduced to 6 credits
in the third week, initially enrolling at 6 credits costs $500.
Report $500 in Item 8A.
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 - CALL-UP 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. If you report 'Yes', you must retain in your
records the student's statement and/or evidence to substantiate their reason(s) for
being unable to complete a course(s) for receiving a non-punitive grade(s).
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 but
withdraws during the fall term. If the student is still enrolled for the spring term,
enter that information in Item 12, "Remarks."
Item 13A - 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.
Item 13B - NAME AND ADDRESS OF SCHOOL OR TRAINING
ESTABLISHMENT: Enter the complete name and address of the school or
training establishment.
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 Veteran Readiness and Employment Records - VA, published in the Federal Register. Your
obligation to respond is required to obtain or retain 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.

SUPERSEDES VA FORM 22-1999b, OCT 2018
WHICH WILL NOT BE USED.

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OMB Approved No. 2900-0156
Respondent Burden: 10 Minutes
Expiration Date: XX/XX/XXXX

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

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

3. CURRENT ADDRESS OF STUDENT

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

5. DATES OF TERM AFFECTED
B. END DATE

A. BEGIN DATE

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

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

C. LAST DATE CREDIT ACCRUED IF DIFFERENT FROM LAST DAY REPORTED IN ITEM 6A (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 NON-PUNITIVE GRADES ASSIGNED
FOR ONE OR MORE COURSES (If checked, complete Item 8)

REDUCTION ON FIRST DAY OF TERM

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

REDUCTION DURING DROP PERIOD

OTHER (Explain in Item 12, Remarks)

REDUCTION AFTER DROP PERIOD - NON-PUNITIVE
GRADES ASSIGNED (If checked, complete Items 9 & 11)
C. CREDIT HOURS BEFORE ADJUSTMENT

D. CREDIT HOURS AFTER ADJUSTMENT

F. CLOCK HOURS OR HIGH SCHOOL UNITS BEFORE
ADJUSTMENT

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. REVISED CHARGES FOR PERIOD OF ENROLLMENT (Complete this item for
chapter 30 students on active duty with an adjusted training load; for ch30/ch35 students
whose training load after adjustment is less than 1/2 time; and all chapter 33 students that
have a change in student status. List the charges for the adjusted load by term or other
period as previously reported)

B. YELLOW RIBBON
(Chapter 33 only)

$

$

NO

1/2 TIME

H. REVISED ENDING DATE

A. TUITION & FEES

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

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

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

MITIGATING CIRCUMSTANCES (Complete only if indicated by Item 6 or 7)
11. DOES THE STUDENT CLAIM THAT TERMINATION OR ADJUSTMENT ACTIONS INVOLVED MITIGATING CIRCUMSTANCES?
YES

NO

UNKNOWN

(If "Yes," you must retain the student's statement and supporting evidence provided in the student's file)

12. REMARKS

IT IS HEREBY CERTIFIED THAT the student's status changed on the date indicated and in accordance with the facts shown above.
13B. SCHOOL OR TRANING ESTABLISHMENT NAME AND ADDRESS

13A. FACILITY CODE

13C. DATE SIGNED

13D. PRINTED NAME AND TITLE OF CERTIFYING OFFICIAL

VA FORM 22-1999b, XXX XXXX

13E. SIGNATURE OF CERTIFYING OFFICIAL

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