2024-25 VA Certification Form

First Name

Middle Name

Last Name

ASC Student ID #

Email Address

Telephone Number

Mailing Address

Country

Street

City

Region

Postal Code

Birthdate

VA File # or SSN (Student)

Parent VA File # or SSN (Chapter 35 ONLY)

Qualifying Veteran First Name (Chapter 35 ONLY)

Qualifying Veteran Last Name (Chapter 35 ONLY)

Do you have remaining eligibility?

Yes

No, benefits have been exhausted

Expected Graduation Date

Program/Major

Enrollment Certification Term(s)

Please select your anticipated hours for each term:

Fall 2024

Spring 2025

Summer 2025

Do you expect to use benefits for each term with hours indicated above? (If not, indicate which term(s) you WILL NOT use benefits)

Any additional comments:

VA Benefit I am Eligible to Receive

Other branch

Agnes Scott Enrollment

I am a new ASC student, and I have never used VA benefits. (If not already submitted, please submit a copy of the VA certificate of eligibility (COE).)

I am a continuing ASC student who attended the previous year.

I am transferring to ASC from another institution, and I have used benefits at my previous institution. (Please submit a copy of your VA certificate of eligibility (COE).)

Please Read

My signature below indicates that:

•   I agree to accept liability and assume responsibility for any overpayments that result from my failure to officially notify the Veterans Certifying Official (Office of Financial Aid) immediately of any changes in enrollment status such as a drop/add, withdrawal, leave of absence, change in school or program.
•   I understand that my benefits from the VA and Yellow Ribbon (if applicable) may vary term to term and within a term based on my enrollment.
• I understand and agree to be responsible for the overpayment that will result if I drop a course or withdraw from a course at any given point within the term.
•   I understand that I will not be paid for excessive elective courses, previously passed courses, or other courses that do not qualify for VA benefits.
• I have submitted a COE to the Veterans Certifying Official (Financial Aid Office).
•   I understand that continued eligibility for VA educational benefits relies on my meeting the VA satisfactory progress standards.
•   I certify that all information contained herein is complete and correct. I authorize ASC to release my academic information to VA to determine my eligibility for educational benefits.
•   I understand that I must complete this form EVERY YEAR at the time of enrollment, and I will not be certified with the VA until I have returned this form to the Veterans Certifying Official in the Office of Financial Aid.

Signature

Date