Form 22-1999 VA Enrollment Certification

OMB Control No. 2900-0073
Respondent Burden: 10 Minutes
Expiration Date: XX/XX/20XX

INSTRUCTIONS AND CERTIFICATIONS FOR
VA ENROLLMENT CERTIFICATION (VA FORM 22-1999)

IMPORTANT: Use Side A for Institutions of Higher Learning (IHL) or schools providing Non-College Degree (NCD) training. Use Side B for Flight,
Correspondence, and Apprenticeship or On-the-Job training programs. Use the Enrollment Manager electronic application to file this information
electronically. Contact your Education Liaison Representative (ELR) for assistance. Read the Certifications below before completing EITHER Items
19D and 19E on Side A OR Items 12D and 12E on Side B. COMPLETE ONLY ONE SIDE OF THIS FORM.

CERTIFICATIONS
IT IS HEREBY CERTIFIED THAT:
• This institution has exercised reasonable diligence in meeting all applicable requirements of Title 38, U.S. Code, and any failure by the institution to
meet any requirements of the law will be reported promptly to VA;
• The course or courses certified are approved by the State Approving agency and are generally acceptable to meet requirements for the student's
educational, professional, or vocational objective;
• No course certified is a repetition of any course previously satisfactorily completed except as permitted by VA regulations;
• This institution holds no power of attorney agreement authorizing the institution to negotiate VA educational assistance allowance checks;
• FOR PRIVATELY OWNED SCHOOLS: The student certified is not an owner or officer of the school nor is the student certified as an official
authorized to sign enrollment certifications;
• This institution agrees to report promptly to VA any enrollment change and any change due to unsatisfactory progress, conduct, or attendance.
• Promptly means within 30 days of the enrollment change. (Except for students receiving benefits under chapter 33, the institution need not report an
enrollment change for a student who was in full-time attendance before the change and in full-time attendance after the enrollment change.);
• Check "Yes," if the student is a Yellow Ribbon Program participant;
• FOR ENROLLMENTS UNDER CHAPTERS 30, 32, 33, 1606: All the 85-15 ratio requirements have been satisfied.

INSTITUTIONS OF HIGHER LEARNING OR SCHOOLS PROVIDING NON-COLLEGE DEGREE TRAINING
IT IS HEREBY CERTIFIED THAT:
• FOR NONCREDIT DEFICIENCY, REMEDIAL, OR REFRESHER COURSES: The courses certified in Item 9C are needed by the student in
order to pursue a program of education at this institution.
• IF REQUESTING ADVANCE PAYMENT: It is agreed that the initial check for this enrollment period will be mailed to the school for temporary
care and delivery to the student upon registration but not more than 30 days before the commencement of training. It is understood that the completion
of a certificate of delivery will normally be required upon delivery of the advance payment. To request advance payment, the beneficiary must
complete Items 15A and 15B. Upon timely receipt of an advance pay request, VA will pay the beneficiary an advance payment of their benefits. An
advance payment includes the first and second months education benefits (of which the first month may be prorated.)

SPECIAL INSTRUCTIONS
STEM SCHOLARSHIP RECIPIENTS - Provide the Classification of Instructional Programs (CIP) code of the reported program in the "Remarks
Section" Item 17. The CIP code is assigned by your school and reported to the Department of Education annually. STEM is only available to Chapter 33
students who have or will soon exhaust their Chapter 33 entitlement. All STEM enrollment certifications should be sent to the Buffalo Processing
Office. (Please refer to the State of Jurisdiction Chart below for Buffalo RPO mailing address.)
YELLOW RIBBON RECIPIENTS - Enter the amount of Yellow Ribbon contributions your institution is making on behalf of the student for each
term, quarter, or semester. If the Yellow Ribbon Program will be used to cover all or a portion of any out of State charges, enter the net total out of State
charges assessed the student.
GUEST STUDENT - If certifying a guest student, place the name of the primary institution in Item 17, "Remarks".
VACATION PERIODS - For non-standard terms only, enter the begin and end date of a vacation period of 7 consecutive days or greater. The begin
date entered should reflect the first day after the last day of class. The end date entered should reflect the last day before class resumes. The vacation
period entered must be identified as a holiday period in your approved catalog.
ACCELERATED PAYMENT INFORMATION - Claimants must complete Items 16A and 16B on Side A to request an accelerated payment.
Chapter 30 and 1606 beneficiaries (or beneficiaries receiving transfer-of-entitlement benefits under these chapters) may qualify for an accelerated
payment. An accelerated payment can only be paid under chapter 30 to claimants enrolled in a high technology program. (A list of programs is on the
Internet at "www.gibill.va.gov".) Beneficiaries seeking an accelerated payment under chapter 1606 must be pursuing a high technology program and
the cost of that program must exceed twice the amount of education benefits otherwise payable for that training.

FLIGHT TRAINING
IT IS HEREBY CERTIFIED THAT:
The student has a Private Pilot's Certificate. I certify that a copy of the student's Class II Medical Certificate as of the beginning date of the enrollment is
on file at this institution. If the student is enrolled in an Airline Transport Pilot course, I certify that a copy of the student's valid Class I Medical
Certificate as of the beginning date of the enrollment is on file at this institution. For all initial enrollment certifications, I have placed the name and date
of the medical certificate in Items 8E and 8F on Side B.
VA FORM
XXX XXXX

22-1999

SUPERSEDES VA FORM 22-1999, AUG 2022,
WHICH WILL NOT BE USED.

Page 1

APPRENTICESHIP AND OTHER OJT PROGRAMS
IT IS HEREBY CERTIFIED THAT:
The employer will immediately notify VA when the trainee receives the journeyman wage. Exceptions to this rule include training on a Davis-Bacon
job, or a job in a geographic location with a different wage scale.

Where to send this form (See exception for STEM Scholarship Recipients):
Step 1: Mail the completed form to the VA Regional Processing Office for the region of that school's physical address. See below for the addresses of the
VA Regional Processing Offices.
Step 2: The beneficiary will wait for VA to process this enrollment certification. The beneficiary will receive notice of our decision. VA will notify the
beneficiary if he or she is determined to not be eligible for education benefits.
Step 3: Exception for STEM Scholarship Recipients only: All enrollment certifications for STEM Scholars should be sent to the Buffalo RPO
address.
NOTE: The enrollment certification can also be submitted Online using Enrollment Manager.

Eastern Region:
VA Regional Office
P.O. Box 4616
Buffalo, NY 14240-4616
SERVES THE FOLLOWING STATES
CO

CT

DC

DE

IA

IL

IN

KS

KY

MA

MD

ME

MI

MN

MO

MT

NC

ND

NE

NH

NJ

NY

OH

PA

RI

SD

TN

VA

VT

WI

WV

WY

APO/FPO AA

FOREIGN SCHOOLS

US VIRGIN ISLANDS

Western Region:
VA Regional Office
P.O. Box 8888
Muskogee, OK 74402-8888
SERVES THE FOLLOWING STATES
AK

AL

AR

AZ

CA

FL

GA

HI

ID

LA

MS

NM

NV

OK

OR

PR

SC

TX

UT

WA

APO / FPO AP

GUAM

PHILIPPINES

AMERICAN SAMOA & MARIANA ISLANDS

PRIVACY ACT: 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 (i.e., 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) VA obtains 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) as identified in the VA
system of records, 58VA21/22/28, Compensation, Pension, Education and Veteran Readiness and Employment Records - VA, published in the Federal
Register. Your response is required to obtain or retain benefits. While you do not have to respond, VA cannot pay the student any education benefits until
we receive the information (38 U.S.C. 3684). Your responses are confidential (38 U.S.C. 5701). Information submitted is subject to verification through
computer matching programs with other agencies.
RESPONDENT BURDEN: An agency may not conduct or sponsor, and a person is not required to respond to, a collection of information unless it
displays a currently valid OMB control number. The OMB control number for this project is 2900-0073, and it expires XX/XX/20XX. Public reporting
burden for this collection of information is estimated to average 10 minutes per respondent, per year, including the time for reviewing instructions,
searching existing data sources, gathering and maintaining the data needed, and completing and reviewing the collection of information. Send comments
regarding this burden estimate and any other aspect of this collection of information, including suggestions for reducing the burden, to VA Reports
Clearance Officer at VACOPaperworkReduAct@va.gov. Please refer to OMB Control No. 2900-0073 in any correspondence. Do not send your
completed VA Form 22-19999 to this email address.

VA FORM 22-1999, XXX XXXX

Page 2

OMB Control No. 2900-0073
Respondent Burden: 10 Minutes
Expiration Date: XX/XX/20XX

NOTE: Tear off and read the Instruction and Certification Sheet before completing the form.

Side

A

VA ENROLLMENT CERTIFICATION
IMPORTANT: Side A is for Institutions of Higher Learning or schools offering non-degree training.
1. NAME OF STUDENT (First, Middle, Last)

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

3. CURRENT ADDRESS OF STUDENT

4. SOCIAL SECURITY NUMBER OF STUDENT (If not entered in Item 2)

5. TYPE OF TRAINING

6. NAME OF PROGRAM

UNDERGRADUATE COLLEGE DEGREE

COOPERATIVE (Not Farm)

GRADUATE OR ADVANCED PROFESSIONAL

FARM COOPERATIVE

NON-COLLEGE DEGREE

GUEST STUDENT

7A. IS STUDENT MATRICULATED AT YOUR FACILITY? (For VA

purposes, a student is matriculated when formally admitted as a
degree seeking student)

(Supplemental School) *Parent
School letter must be on file))

HIGH SCHOOL
STEM SCHOLARSHIP

YES

NO

7B. YELLOW RIBBON RECIPIENT?

YES

NO

ENROLLMENT DATA
9. COURSES TAKEN
8. DATE STUDENT ENROLLED
IN CURRENT COURSE

(MM/DD/YYYY)

A. BEGIN

CREDIT HOUR COURSE(S) NON-CREDIT
TAKEN
INRESIDENCE

TAKEN
ONLINE

REMEDIAL/
DEFICIENCY/
REFRESHER

A. HOURS

B. HOURS

C. HOURS

B. END

14. VACATION PERIODS
B. END

11. CHARGES
FOR PERIODS
OF INSTRUCTION

HOURS

TUITION AND FEES

12. YELLOW
RIBBON
PROGRAM
A. AMOUNT

B. OUT OF
STATE CHARGES

13. TRAINING
TIME

(Graduate or
Advanced
Professional
Program)

15. ADDITIONAL INFORMATION FOR HIGH SCHOOL AND FARM CO-OP COURSES

(MM/DD/YYYY)

A. BEGIN

10. CLOCK
HOURS
PER WEEK

A. HIGH SCHOOLS APPROVED ON A UNIT BASIS (Enter the number of high school units for which the student is enrolled. If more than

one term is reported in Items 8A and 8B, please report the number of units in consecutive order from left to right for question 15A.)

B. FARM CO-OP ONLY (Is student pursuing course concurrently with substantially full-time agricultural employment averaging at
least 40 hours per week?)
YES
NO

ADVANCE PAYMENT REQUEST (Note: Advance payment is not accelerated payment) (See Special Instructions)

I REQUEST AN
ADVANCE PAYMENT

16A. SIGNATURE OF STUDENT

16B. DATE SIGNED (MM/DD/YYYY)

ACCELERATED PAYMENT REQUEST
(Note: Accelerated payment is not advance payment) (See Special Instructions)
I am requesting an accelerated payment under either chapter 30 or 1606. If I am requesting payment under chapter 30, I certify I intend to seek employment in one of the
following industries: Biotechnology, Life Science Technologies, Opto-electronics, Computers and Telecommunications, Electronics, Computer-integrated Manufacturing,
Material Design, Aerospace, Weapons, or Nuclear Technology.

I REQUEST AN
ACCELERATED PAYMENT
(Chapter 30 or 1606 only)

16C. SIGNATURE OF STUDENT

16D. DATE SIGNED (MM/DD/YYYY)

17. REMARKS

NOTE - Complete Item 18 only if course(s) are contracted out to another school or are given at a branch location other than shown in Item 19B. Do not complete Item 18
if course(s) are taken at a branch or extension of a school as defined in 38 CFR 21.4266(c).
18. NAME AND ADDRESS OF CONTRACT SCHOOL OR BRANCH LOCATION

CERTIFICATIONS - The provisions described in paragraphs (1) through (14) on the attached sheet are certified if applicable.
19A. FACILITY CODE

19B. SCHOOL NAME AND ADDRESS

19C. TELEPHONE NUMBER OF CERTIFYING OFFICIAL

19D. SIGNATURE OF CERTIFYING OFFICIAL

VA FORM
XXX XXXX

22-1999

SUPERSEDES VA FORM 22-1999, AUG 2022,
WHICH WILL NOT BE USED.

19E. DATE SIGNED (MM/DD/YYYY)

SELECT COPY

OMB Control No. 2900-0073
Respondent Burden: 10 Minutes
Expiration Date: XX/XX/20XX

NOTE: Tear off the Instructions and Certifications sheet before completing the form.

Side

B

VA ENROLLMENT CERTIFICATION
IMPORTANT: Side B is for flight, correspondence, and apprenticeship or on-the-job training programs.
1. NAME OF STUDENT (First, Middle, Last)

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

3. CURRENT ADDRESS OF STUDENT

4. SOCIAL SECURITY NUMBER OF STUDENT (If not entered in Item 2)
5. NAME OF PROGRAM
7. CREDIT FOR PREVIOUS TRAINING (Not Flight)

6. TYPE OF TRAINING
FLIGHT TRAINING
CORRESPONDENCE
APPRENTICESHIP OR OTHER ON-THE-JOB

VOCATIONAL FLIGHT TRAINING (See Instructions)
8A. CREDIT ALLOWED FOR PREVIOUS EDUCATION AND TRAINING
DUAL

DUAL SIMULATOR

DUAL

DUAL SIMULATOR

SOLO

GROUND SCHOOL

8B. DATE OF ENROLLMENT IN
CURRENT COURSE (MM/DD/YYYY)

CERTIFICATES AND RATINGS

8C. NUMBER OF HOURS/UNITS OF INSTRUCTION IN CURRENT COURSE
SOLO

GROUND SCHOOL

8D. TOTAL CHARGES

PRE- AND POST
FLIGHT

$
8F. DATE OF LAST EXAMINATION

8E. CLASS OF MEDICAL CERTIFICATE HELD BY STUDENT ON DATE OF ENROLLMENT IN THIS FLIGHT COURSE

(MM/DD/YYYY)

CORRESPONDENCE TRAINING
IMPORTANT: A VA Form 22-1999c, Certificate of Affirmation of Enrollment Agreement, MUST be signed by this student and accompany this
certification form before VA can authorize payment for this correspondence course.
9A. DATE FIRST LESSON SENT
TO STUDENT (MM/DD/YYYY)

9B. NUMBER OF LESSONS FOR
WHICH STUDENT IS ENROLLED

9C. CHARGE PER LESSON TO
STUDENT

9D. WERE ANY LESSONS SERVICED BEFORE THE
DATE ENTERED IN ITEM 9A?
YES
NO

(If "Yes," show lesson number and
date serviced in Item 11, "Remarks")

APPRENTICESHIP AND ON-THE-JOB TRAINING
10A. TRAINING DATES

(MM/DD/YYYY)

BEGINNING

ENDING

10B. TYPE OF TRAINING
APPRENTICESHIP

10C. NUMBER OF HOURS TRAINEE IS
EMPLOYED PER WEEK
IN TRAINING PROGRAM

ON-THE-JOB

10D. NUMBER OF HOURS IN
STANDARD WORK WEEK

HRS.
HRS.
HRS.

HRS.
HRS.
HRS.

11. REMARKS (You may show monthly number of hours worked to date here or use VA Form 22-6553d-1)

CERTIFICATIONS - The provisions described in paragraphs (1) through (15) on the attached sheet are certified if applicable.
12A. FACILITY CODE

12B. SCHOOL NAME AND ADDRESS

12C. TELEPHONE NUMBER OF CERTIFYING OFFICIAL

12D. SIGNATURE OF CERTIFYING OFFICIAL

VA FORM
XXX XXXX

22-1999

SUPERSEDES VA FORM 22-1999, AUG 2022,
WHICH WILL NOT BE USED.

12E. DATE SIGNED (MM/DD/YYYY)

SELECT COPY