GI Bill® Certification Worksheet

GI Bill® Certification Worksheet

*Certification requests must be accompanied by a copy of your Certificate of Eligibility if one has not been previously provided.
Name

First NameLast Name
RIC Student ID Number
*Enter Full Student ID (all 7 digits)
Current Program of Study / Major
Phone Number

Area CodePhone Number
Email
example@example.com
VA Education Benefit: Please check your current chapter status
Chapter 31 VR&E Case Manager Name
Are You the Veteran, Spouse, or Dependent?
Using a STAP Waiver
Using Disabled American Veteran (DAV) Waiver
Please Indicate the Semester You Need Certification*
*Certification worksheet/request is required for all terms you intend to use VA education benefits and when any changes in enrollment are made.
Total Registered Credits
Are You Completing a Clinical or Internship Placement This Semester?
Location
Is It Your Intent to Waive RIC Accident and Health Insurance?*
* It is the student's responsibility to waive health insurance from their account. Indicating "Yes" on this form does not result in your insurance being waived.
Are you using CHAMPVA and need your school attendance verification sent to CHAMPVA? (This generally applies to Chapter 35 funded students, contact the MRC with questions)
If you haven’t done so already, you will need to include a copy of your Certificate of Eligibility (COE) before your enrollment can be reported to VA. Upload your copy here:

Browse Files
If your COE has already been sent with a previous request, or provided to the Registrar, it does not need to be provided again. VR&E (Chapter 31) students do not need to provide a COE as benefits are verified using another process Cancelof
Initials
Important Info Regarding Your VA Payment

Please check that you read and understand the information:

Notify the Certifying Official immediately if you change your schedule, drop a class, withdraw from a class, etc. Also, it is your responsibility to provide verification of Mitigating Circumstances.

Signature Required: I attest the information above is true and accurate. I understand that I am responsible for any unpaid balance that the VA does not cover. This is a RIC form and must be completed every semester.
Signature
Date

MonthDayYear
2 digit month, 2 digit day, 4 digit yearDate
GI Bill® is a registered trademark of the U.S. Department of Veterans Affairs (VA). More information about education benefits offered by VA is available at the official U.S. government Web site at http://www.benefits.va.gov/gibill.
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GI Bill® Certification Worksheet

Important Info Regarding Your VA Payment