Enrollment Form

Online VA Certification Enrollment Form

This form must be submitted, each semester, after registering for classes.

Social security number
Your Binghamton ID Number
CH 35 Only - VA claim number (usually ssn of enrollee)
Use your Binghamton email. Non-Binghamton emails can be delayed.
Please provide current street name and number, city, state and zip code
Select the VA Benefit you plan to use
Is this a Benefit or Program change from the previous semester or term?
Voc Rehab Only - Case Manager Name
Voc Rehab Only, Case Manager Email
Are you a:
This enrollment is for which Term?
What is your current benefit status?
Class Level
What degree are you studying for
Have you changed your major and/or program since your last certification?
If yes, VA Form 22-1995 or 22-5495 (CH 35) must be submitted.
Are you currently active duty


Statement of Understanding


1. I will report any registration changes (add, drop, S/U, withdrawal, etc.) to the certifying official.

2. I will notify the certifying official if I stop attending class(s).

3. I will notify the certifying official if I change my major or degree program.

4. I understand that grades "W" and "U" may result in reduced payment from VA.

5. I understand that classes scheduled to meet for less than the normal semester term dates may be paid at a different rate based on the number of credits and the length of the class. 

6. I understand that repeated classes for which I have received a grade cannot be used for my certification.

7. I understand that if I fail to comply with the above, it can result in an over or underpayment of benefits.  VA will hold me responsible for over payment of my education benefits.

My signature below indicates that I understand the above guidelines and that I must complete a new Veterans Enrollment Form for each semester of attendance that I wish to receive benefits.

Note: VA will not pay for a graduate student taking undergarduate courses.
 

Problems submitting the online form?

If you experience a problem using the online form, please contact Veteran and Military Services Office.