Form VA Form 22-8794 VA Form 22-8794 Designation of Certifying Official(s)

OMB Approved No. 2900-0262
Respondent Burden: 10 Minutes

DESIGNATION OF CERTIFYING OFFICIAL(S)
GENERAL INSTRUCTIONS
1. This form MUST ONLY be completed by a responsible official with the authority to designate certifying officials for the school or
training establishment.
2. This form must be completed whenever there is a change in any of the information. Include the names, titles, and signatures of all
certifying officials, not just the changed information.
SPECIFIC INSTRUCTIONS
1. Item 1: Enter the complete name and address of the school or training establishment.
2. Item 2: Enter the certifying official's telephone number.
3. Item 3: Enter the certifying official's fax number.
4. Item 4: Enter the certifying official's e-mail address. As an alternative, you may enter the e-mail address for the office where the
certifying official works.
5. Item 5A: Enter the complete name and title for each designated certifying official. Have each person sign the form on the same line
as his or her name and title. If any of the certifying officials have limited jurisdiction, note such limitations in Item 6, "Remarks". Use
space below if needed.
6. Item 5B: If facsimile (e.g., rubber stamp) signatures will be used for any certifying officials, enter a sample in the appropriate block.
In addition, have the individual initial next to the sample.
7. Item 5C: If veterans and other eligible persons will be claiming individualized tutorial assistance, complete these blocks.
8. Items 7 and 8: Sign and date the form. The person signing the form must be a person of significant authority, i.e., registrar,
academic dean, or higher.
PURPOSE: This form is used to provide the names and signatures of those individuals who are authorized to certify enrollment information to the
Department of Veterans Affairs.
1. NAME AND ADDRESS OF SCHOOL OR TRAINING ESTABLISHMENT (Include ZIP Code)

FOR VA USE ONLY

2. TELEPHONE NUMBER(S) OF CERTIFYING OFFICIAL(S) (Include Area Code)

3. FAX NUMBER OF CERTIFYING OFFICIAL(S) (Include Area Code)

4. E-MAIL ADDRESS OF CERTIFYING OFFICIAL(S)

5. THE FOLLOWING ARE DESIGNATED AS CERTIFYING OFFICIALS OF THIS SCHOOL OR TRAINING ESTABLISHMENT
A. OFFICIALS DESIGNATED TO SIGN VA ENROLLMENT CERTIFICATIONS, CERTIFICATIONS OF CHANGE IN STUDENT STATUS, CERTIFICATIONS OF DELIVERY OF
ADVANCE PAYMENTS, CERTIFICATIONS OF PURSUIT, ATTENDANCE, FLIGHT TRAINING, ON-THE-JOB OR APPRENTICESHIP TRAINING (AS APPLICABLE), OTHER
CERTIFICATIONS OF ENROLLMENT ARE:
NO.

NAME

TITLE

SIGNATURE

(1)

(2)

(3)

(4)
B. THE USE OF THE FOLLOWING FACSIMILE (e.g., rubber stamp) SIGNATURES FOR THE OFFICIALS LISTED IN ITEM 5A ABOVE ARE AUTHORIZED.
(1)

(2)

(3)

(4)

VA FORM
JAN 2007

22-8794

EXISTING STOCKS OF VA FORM 22-8794,
NOV 2003, WILL BE USED.

(See Reverse)

5. THE FOLLOWING ARE DESIGNATED AS CERTIFYING OFFICIALS OF THIS SCHOOL
OR TRAINING ESTABLISHMENT (Continued)
C. FOR POSTSECONDARY EDUCATIONAL INSTITUTIONS ONLY - OFFICIALS DESIGNATED TO SIGN THE SCHOOL PORTION OF VA FORM 22-1990T, APPLICATION
AND ENROLLMENT CERTIFICATION FOR INDIVIDUALIZED TUTORIAL ASSISTANCE, ARE:
NO.

NAME

TITLE

SIGNATURE

(1)

(2)

(3)

6. REMARKS

It is hereby certified that the Department of Veterans Affairs will be notified of any changes in the designations shown on this form as they occur.
7. SIGNATURE AND TITLE OF DESIGNATING OFFICIAL

8. DATE

PENALTY - The law provides that whoever makes any statement of a material fact knowing it to be false shall be punished by fine or imprisonment or both.

PRIVACY ACT NOTICE: 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 as identified in the VA system of records, 58VA21/22,
Compensation, Pension, Education and Rehabilitation Records - VA, and published in the Federal Register. An example of a routine use (e.g.,
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) for VA to obtain 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). Your obligation to respond is required to obtain or
retain education benefits. VA cannot recognize you as the proper certifying official unless the information is furnished as required by existing
law (38 U.S.C. 3680(g)). The responses you submit are considered confidential (38 U.S.C. 5701). Any information provided by applicants,
recipients, and others is subject to verification through computer matching programs with other agencies.
RESPONDENT BURDEN: We need this information to identify you as the certifying official for your school or job training establishment
when reporting pursuit of training for veterans and other eligible persons (38 U.S.C. 3684). Title 38, United States Code, 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.whitehouse.gov/library/omb/OMBINV.VA.EPA.html#VA. 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 22-8794, JAN 2007