Initial VA Certification Request Form

Initial VA Certification Request

Merrimack College students using VA educational benefits are required to complete a Certification Request form prior to starting their first semester. Please note that failure to complete a Certification Request may delay your benefits. This form is used to provide all of the information necessary to create an enrollment verification file with the Veterans Administration.

First Name

Last Name

Merrimack ID

Merrimack Email Address

Military Branch

*If you are receiving benefits as a spouse or dependent, please indicate the branch of the soldier from whom the benefits are being used.

Military Status

*If you are receiving benefits as a spouse or dependent, please indicate the status of the soldier from whom the benefits are being used.

What is your degree program / What degree program are you enrolling in?

What term are you enrolling in?

What is your benefit level?

Please provide the veteran’s full name and social security number. Alternatively, you can call 978-873-5943 to share this information. Please be aware that certification will not be completed until this information is received.

Veteran's Full Name

Veteran's Social Security Number

Please explain:

What is your relationship to the benefit holder?

Upload a copy of your Certificate of Eligibility here

Notice of Responsibilities

Please read each statement below and check all boxes to acknowledge that you have read and understand.

I understand that I am responsible for paying all balances on my account not paid for by the VA. If I am not awarded 100%, I will pay the remaining balance by the bill due date for the amount I am responsible for paying. Failure to do so could result in a late fee and registration hold.

I understand that Merrimack College will only certify my benefits to the VA once I have provided my authentic Certificate of Eligibility. *Please note: this is not applicable to Ch 31 students.

I understand that if I have questions about my benefits, I can call the VA at 888-442-4551. College certifying officials are not able to provide or discuss payment details.

I understand that I am responsible for housing and meal plan charges because the VA does not cover these.

I understand that it is my responsibility to notify the school certifying official when I add, drop, or withdraw from classes, or if I change my program. Any delay in reporting can cause incorrect payments or incur debt.

I understand that it is my responsibility to be aware of my benefit amount and delimiting date. When I exhaust my VA benefits, there may be a balance remaining on my student account that is my responsibility.

I understand that all courses must count towards completion of a degree program. Ensuring this requirement is the responsibility of the student.

The Merrimack College Certifying Official will certify your program, credit hours, dates of attendance, and tuition & fees to the VA in two steps. The first certification will be processed when we receive the Certification Request form once you are done registering for the first semester. The second certification will be processed after the Add/Drop period is over (each semester).

By signing below, I understand my reporting and payment responsibilities.

Electronic Signature

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Initial VA Certification Request Form