VA Enrollment Certification Request Form

* Required

Submitted Wednesday, May 31, 2023

Important: Please read the information below before completing the form.

This form should be completed each semester to indicate all of the courses you wish to have certified with the VA. DO NOT SUBMIT THIS FORM IF YOU HAVE NOT REGISTERED FOR CLASSES YET.

If this is your first semester or term at Capitol make sure that you have provided the VA School Certifying Official with your Certificate of Eligibility (COE) or VR&E authorization form (sent by your VR&E counselor).

We will use the information provided on this form to certify your benefits after the add period has closed for each term/semester. You can also use this form to request certification for prior semesters. You cannot be certified if you have not provided Capitol with your Social Security Number. If you have any questions please send an email to VABenefits@CapTechU.edu

First Name:

Last Name:

Student ID:

Email Address:

Semester:

Year:

Term (complete a separate form for each term) :

LIST THE COURSES FOR WHICH YOU ARE SEEKING BENEFITS. INFORMATION NOT PROVIDED MAY DELAY YOUR BENEFITS.

COURSE 1

Course Number, Section and Title (Example EN 101 D01 English Composition):

COURSE 2