​Request for Certification of Veterans Education Benefits
* indicates a required field

Student ID Number *

Enter your Shasta College Student ID Number

Student Name *

Last, First, MI

Email Address *

Enter your email address
Example: student@mail.com

Mailing Address *

Enter street address or PO Box
City, State, Zip

Last 4 Digits SSN *

Enter the last 4 digits of your Social Security Number

Phone Number *

Which semester are you requesting certification? *

What VA Education Benefit will you be using? *

What is your academic objective (select one)? *

What is your major? *

List degree title. For example: University Studies - Social Science,
Welding, General Studies - Industrial Technology

Degree/Certificate Code *

For a list of degree/certificate codes, visit http://www.shastacollege.edu/degreecodes

How many units are you currently registered for? *

Do not include waitlisted courses.

List all other prior colleges attended: *

List all colleges attended before, during & after military service.
Enter "None" if you have not attended any prior institutions.

I have met with the Veterans Counselor for an Educational Plan. *

NOTE: Each time you change your program of study, you are
required to update your Educational Plan by meeting with the
Veterans Counselor.

I understand the VA will only pay for courses required for graduation. *

The VA will not cover recommended or suggested courses,
electives, audits, challenged courses, course repeats, or any
course that is not required for your current educational objective

I will promptly notify Shasta College Veteran Services of schedule changes. *

Email jfisher@shastacollege.edu to report any adds, drops, or withdrawals.

I understand I must make academic progress to continue receiving benefits. *

Refer to the Scholastic Deficiency Policy in the Shasta
College Catalog for information.

I am aware enrolling in short term courses may affect my training time. *

Rate of pursuit/training time may vary when enrolling in late start/short term courses resulting in a change in payment rates.

I will submit this request form each term I want to use benefits. *

Failure to submit this request form will result in an interruption of education benefit payments. Submit this form after enrolling in classes.

Additional Information for Certifying Official:

Provide information or notes for the Certifying Official.  (Examples: Rounding Out; conserving entitlement; enrolled in elective courses not covered by VA; recently changed my program of study, etc.)