Veterans Certification Form

The completion of this form authorizes Missouri State-West Plains to provide required information and to certify your enrollment for a specified semester to the Department of Veterans Affairs, St. Louis, MO.

Mailing Address:

Please check the appropriate category:
CH 31 Disabled Veterans/Vocational Rehabilitation
CH 1607 REAP – Reservists called to active duty after 9/11/01

AA-Associate of Arts in General Studies AA-Associate of Arts in Teaching AS-Associate of Science in Nursing
AAS-Associate of Applied Science in: Business, Child and Family Development, Computer Graphics and Programming, Computer Technology, Enology, Entrepreneurship, General Agriculture, General Technology, Law Enforcement, Respiratory Therapy, Viticulture

Fall Spring Summer Year

Yes No
• If yes, you must complete a Change of Program or Place of Training form (22-1995) on the VA website

  • Continuing Student: Have received benefits before at Missouri State University-West Plains
  • New Applicant: Applying for VA benefits for the first time
  • Transfer Student: Transferring from another institution where I used veterans benefits

Class Schedule

Begin Date-End DateCourse CodeCourse #Credit HoursRepeat

I understand that…

  • Dropping or adding classes
  • Enrolling in an unauthorized repeat of a class
  • Enrolling in courses that do not apply towards your program of study or
  • Enrolling in classes with various beginning and ending dates such as intersession classes, LWE classes and certain summer classes.
If I have questions regarding my VA eligibility or payment amounts, I should call the Department of VA at (888) 442-4551.

My signature below indicates that I understand the above guidelines and that I must complete a new Veterans Certification Request form each semester in order to receive veterans’ educational benefits.



Student Signature Date