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

OMB Approved No. 2900-0262
Respondent Burden: 10 Minutes
Expiration Date: XX/XX/XXXX

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
Item 1. Enter the complete name and address of the school or training establishment.
Item 2A. Primary Certifying Official: Enter complete name and title for the individual at the facility who will act as the
primary certifying official. This person must sign the form on the same line as his or her name and title. Provide this
individual's direct telephone number and email address. The individual must validate that he or she has fulfilled any
mandatory school training requirements.
Item 2B. Additional Certifying Officials: Enter the complete name and title for each remaining designated certifying
official. Have each person sign the form on the same line as his or her name and title. Provide individual's direct
telephone number and email address. The individual must validate that he or she has fulfilled any mandatory training
requirements. Include copies of training certificates for any newly designated certifying officials when submitting this form.
Item 3. Use Item 3, (Remarks) if additional space is needed.
Items 4 and 5. Sign and date the form.
Item 6. Print name and title of designating official. The person signing the form must be a person of significant authority,
(i.e., registrar, academic dean, or higher).
Items 7 and 8. Provide email address and direct telephone number.

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)

2A. THE PRIMARY CERTIFYING OFFICIAL ACTS AS THE PRIMARY POINT OF CONTACT AT THE TRAINING FACILITY. RELATED INQUIRIES
AND CORRESPONDENCE WILL BE DIRECTED TO THE ATTENTION OF THIS INDIVIDUAL. THE FOLLOWING INDIVIDUAL IS DESIGNATED AS
THE PRIMARY CERTIFYING OFFICIAL FOR THE SCHOOL OR TRAINING ESTABLISHMENT NAMED IN ITEM 1:
NAME

TITLE

TELEPHONE NUMBER (Include Area Code)

EMAIL

VA FORM
XXX XXXX

22-8794

SUPERSEDES VA FORM 22-8794, MAY 2018,
WHICH WILL NOT BE USED.

SIGNATURE

DATE
(Provide the date Section 305 training requirement was met)

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2B. THE FOLLOWING ARE DESIGNATED AS ADDITIONAL CERTIFYING OFFICIALS OF THIS SCHOOL OR TRAINING ESTABLISHMENT.
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), SCHOOL PORTION OF VA FORM 22-1990T, APPLICATION FOR INDIVIDUALIZED
TUTORIAL ASSISTANCE AND OTHER CERTIFICATIONS OF ENROLLEMENT:

(1)

NAME

TITLE

SIGNATURE

TELEPHONE NUMBER (Include Area Code)

EMAIL

DATE
(Provide the date Section 305 training requirement was met)

NAME

TITLE

SIGNATURE

TELEPHONE NUMBER (Include Area Code)

EMAIL

DATE
(Provide the date Section 305 training requirement was met)

NAME

TITLE

SIGNATURE

TELEPHONE NUMBER (Include Area Code)

EMAIL

DATE
(Provide the date Section 305 training requirement was met)

NAME

TITLE

SIGNATURE

TELEPHONE NUMBER (Include Area Code)

EMAIL

DATE
(Provide the date Section 305 training requirement was met)

(2)

(3)

(4)

2C. IT IS ACKOWLEDGED THAT EACH OF THE INDIVIDUALS NEWLY DESIGNATED AS CERTIFYING OFFICIALS HAVE COMPLETED ONLINE
TRAINING FOR NEW CERTIFYING OFFICIALS. INDIVIDUALS REQUESTING "READ ONLY" ACCESS ARE NOT REQUIRED TO COMPLETE THIS
TRAINING. INDICATE IN ITEM 3, (REMARKS) IF A CERTIFYING OFFICIAL IS IN RECEIPT OF VA EDUCATION BENEFITS. IT IS HEREBY
CERTIFIED THAT THE DEPARTMENT OF VETERANS AFFAIRS WILL BE NOTIFIED OF ANY CHANGES IN THE DESIGNATIONS SHOWN ON THIS
FORM, TO INCLUDE CHANGES IN CONTACT INFORMATION, AS THEY OCCUR.
NO.

NAME

NO.

(1)

(6)

(2)

(7)

(3)

(8)

(4)

(9)

(5)

(10)

VA FORM 22-8794, XXX XXXX

NAME

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3. REMARKS

4. SIGNATURE OF DESIGNATING OFFICIAL

7. EMAIL ADDRESS

5. DATE

6. PRINT NAME AND TITLE

8. TELEPHONE NUMBER (Include Area Code)

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, 58VA21/22/28, Compensation, Pension, Education, Vocational Rehabilitation
and Employment Records - VA, 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.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 22-8794, XXX XXXX

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