VA Benefits Quarterly Certification Authorization Form Header Image

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You are being asked to complete this form to request that your benefits be certified for the upcoming quarter. If you are electing not to use your benefits this quarter, please email veterans@cityu.edu so that your account can be notated accordingly. 

Please note that your progress on this form will not be saved if you leave this site.

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If you would prefer to complete a physical form, please select "No" below and enter your information so that our office can contact you with a physical form.

Do you opt in to completing this form electronically?*

Student Information

Name*
Address*

VA Benefits Quarterly Certification Authorization Form

Is this your first time using Veteran's benefits at CityU?*

Please note that you may need to complete forms in addition to this form. Please refer to the To-Do List in your CityU Student Center.

VA Chapter*
Please provide a copy of your approved TA voucher.*
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Please note that you may need to complete forms in addition to this form. Please refer to the To-Do List in your CityU Student Center.

If you are only using tuition assistance and will not be using VA Education Benefits, this form is not needed. Please submit your TA to billing@cityu.edu.

Quarter of Enrollment*
Course Mode (if known)
Check below all other forms of aid you're using:
Are you enrolling in courses at another institution?*
Are you requesting Advance Pay for this quarter?*
Please note that Advance Pay cannot be processed for Chapter 31 or Chapter 33. Requests for Advance Pay MUST be made 45 days before the beginning of the quarter in which you are certified.

Courses at Another Institution

All courses taken at another institution must successfully transfer into your program plan at City University of Seattle in order to use your VA educational benefits concurrently at both schools. To see if a course at another institution will transfer to our school, contact the VA Certifying Official at veterans@cityu.edu or 206-239-4539. 

Course Start Date*
Course End Date*
Do you need to list an additional course?*
Course Start Date*
Course End Date*
Do you need to list an additional course?*
Course Start Date*
Course End Date*

If you are taking more than three courses at other institutions, please contact the Veterans Affairs Office at veterans@cityu.edu. 

Advance Pay

I understand that I must complete this section of the form 45 days prior to the beginning of the quarter in order to receive Advance Pay. If this section is completed fewer than 45 days from the beginning of the quarter, Advance Pay will not be processed. 

I understand that Advance Pay will pay for the first and second month of the quarter. The first month may be a partial month, with payment prorated for the number of days attended that month. 

I certify that the information provided in this section is true and correct as of the date of my signature.*
Please type your full legal name.

Statement of Understanding

I understand that I am required to contact the Veteran Affairs Officer each quarter that I intend to use my VA Benefits. 

I understand that if I do not contact the Veterean Affairs Officer, I will not be certified and I will not be paid for the quarter. 

I understand that if the classes I am enrolled in are not on my program plan, then the VA will not cover the tuition for those classes. Only program requirements and approved electives can be approved for receipt of Veteran's benefits. 

In order to prevent overpayment of benefits, I understand that it is my responsibility to report any changes in quarter hours, enrollment status, program of study, mailing address, number of dependents, or any other change I believe may change my VA status. 

I understand that the VA is required to take prompt and aggressive action to recover overpayments, that the VA may add interest and collection fees to the debt if an overpayment is not repaid, and that VA may also refer the debt to a private collection agency or may take other action to collect the debt. 

Statement of Understanding for Monthly Housing Allowance (MHA/BAH)

I understand that I must maintain more than half-time enrollment throughout the quarter. 

For undergraduate students, this is a minimum of seven (7) credit hours; for graduate students, this is a minimum of four (4) credit hours. 

I understand that the type of class(es) I take will determine my MHA rate. 

At least one in-class or mixed-mode course is needed to qualify for MHA of E5+Dependents based on the school's zip code. Otherwise, taking only online classes will result in the lower rate of 50% national average. 

I understand that the number of credits I take that are less than full-time determines my Rate of Pursuit, or the percentage for which I will be paid. 

For undergraduate students, this is a minimum of twelve (12) credit hours; for graduate students, this is a minimum of (6) credit hours.

I understand that MHA payments will be prorated for the number of days in a month if not enrolled throughout the entire month. Each month, no matter how many days are in the month, is calculated as a 30-day month. 

I understand that the percentage I am approved for will be applied to my MHA eligibility as well.

I understand that MHA payments are made one month in arrears, meaning that the payment is delayed one month after it is earned.

Signature

I certify that the information provided on this form is true and correct as of the date of my signature.*
Please type your full legal name.
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