VA Benefits Certification Request Form

VA Benefits Certification Request Form

Before you begin, have a copy of your schedule to refer to & look up how many months and days of entitlement you have remaining. See below for methods of finding this out. To see a short video about filling out this form, scroll down to the bottom of the page.
Name*

First NameLast Name
Lipscomb ID*
L Number
Student Email Address*
Current Phone Number*
Schedule Type for This Semester:*

First SubmissionAdding the following classesDropping the following classes
Student Type:*

Traditional Student (on-campus)Online Student (100% online)
Semester*
(You must submit a separate CRF for each semester. If you are registered for classes in multiple semesters, you must submit a separate CRF for each individual semester.)
Benefit Type*
(If you're not sure, contact our office!)
Amount of Remaining Entitlement
(Ways to find: Look at eBenefits, Check your last award letter, Call 1-888-442-4551)
Months Remaining*
(Must be 2 digits - for 2, enter 02)
Days Remaining*
(Must be 2 digits)

(Use this as an example for the table below - please refer to your schedule)

Courses Registered - Use example above and refer to your class schedule*

Degree Type*

UndergraduateGraduateDoctoral
My Degree Program*
(e.g. BS in Mechanical Engineering)
Concentration*
(enter 'NA' if none)
Minor(s)
All of these classes are required for my graduation:*

YesNo
I am choosing to attend "Hybrid" sessions (Lipscomb Online students only - must also submit Hybrid Declaration Form)

YesNo
I will be graduating at the end of this semester:*

YesNo
I know that I must notify Veteran Services of ALL schedule changes:*

YesNo
I know that I must continue to attend all classes to receive VA Educational Benefits:*

YesNo
Typing your name in this blank is equivalent to signing your legal signature, giving Lipscomb University permission to submit this enrollment information to Veterans Affairs.*
Date*
Youtube
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