Registrar’s Office • Clinton Community College • 136 Clinton Point Drive • Plattsburgh, NY 12901

Tel: (518) 562-4266 • Fax: (518) 562-4118 • Email:

Request for Certification of VA Education Benefits

Student Name: ______SSN: ______

If you are a veteran or dependent of a veteran and would like the Assistant Registrar/Veterans Affairs Coordinator at Clinton Community College to certify your GI Bill, answer the questions below and submit this form to the Registrar’s Office. It is your responsibility to request certification each semester in which you would like to receive the GI Bill. This completed form with its pertinent attachments does allow the Assistant Registrar to certify your GI Bill, but you will also have to see the Assistant Registrar to obtain a Request for Deferral form to be used to defer any portion of your student bill due to pending GI Bill funds.

  1. What term would you like the Assistant Registrar to certify you under the GI Bill (Check only one)?

 Spring 2015  Summer 2015  Fall 2015  Winter 2015

  1. How many credit hours have I registered for in this term? ______hours
  1. What Chapter of the GI Bill are you eligible for and using in this term (Check only one)?
  1. If you have Chapter 33, what is your eligibility percentage? ______%

*Please note that you are not eligible to receive the NYSTuition Assistance Program (TAP) if you are using Chapter 33with 100% eligibility.

  1. Have you applied for the NYS Tuition Assistance Program (TAP) for this academic year?

 Yes, I applied for TAP already.  Not yet, but I plan to apply for TAP.  No, I don’t plan to apply for TAP.

  1. If you have Chapter 35, what is the veteran’s VA File Number? ______

*Please note that this is the veteran’s social security number and not the dependent’s.

  1. Complete the following if this is your first semester of certification at Clinton Community College:

 Attach a copy of your Certificate of Eligibility

(Apply here: )

 If you have received the GI Bill at another college or institution of higher learning, please fill out and attach a Request for Change of Program or Place of Training Form (22-1995) to this form as well by going to the following website and printing out the form:

By signing below, I certify this information is accurate to the best of my knowledge and that I have not exhausted all of my GI Bill benefits prior to the beginning of the semester that I have indicated above.

______

Signature Date