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Get VA 22-1999c 2017-2024

Your facility the school should submit VA COPY 1 of VA Form 22-1999c Certificate of Affirmation of Enrollment Agreement For Correspondence Course and VA Form 22-1999 Enrollment Certification to the Department of Veterans Affairs. By signing this form I affirm such enrollment agreement and certify under penalty of law that I have not signed this affirmation certificate until after the expiration of 5 full days after the date I signed the aforesaid SUBMIT WITH ENROLLMENT CERTIFICATION INSTRUCTION TO CLAIMANT After completion of Items 6 and 7 on or after the 7th day return VA COPY 1 and SCHOOL COPY 2 of this form to the school identified in Item 5. VA FILE NO. 5. NAME AND ADDRESS OF SCHOOL PURPOSE OF THE AFFIRMATION PROVISION OF LAW To provide you time no less than five full days following your signing of an enrollment agreement during which you can reflect on your decision to enroll in a correspondence course and determine if such correspondence course is suitable to your abilities and interests. The Correspondence School Agreement you have signed is not effective unless you complete this form and return it to the school. AFFIRMATION PROCEDURE A. Decision to Affirm - If you decide to affirm the Correspondence School Agreement you have signed you may affirm only after the expiration of 5 full days after the day on which the agreement was signed. For example if the contract was signed on the 1st day of a month you must sign and date this affirmation certification form on or after the 7th day. VA WILL NOT ACCEPT ANY AFFIRMATION YOU SIGN BEFORE THE 7TH DAY. VA WILL NOT PAY FOR LESSONS THAT YOU COMPLETE AND THE SCHOOL SERVICES BEFORE THE PROPER AFFIRMATION DATE. TO AFFIRM READ THE FOLLOWING PARAGRAPH AND COMPLETE ITEMS 6 AND 7 BELOW I have read and I understand the enrollment agreement that I entered into with the above named school on the date indicated in Item 4. OMB Control No* 2900-0576 Respondent Burden 3 Minutes Expiration Date 7/31/2017 CERTIFICATE OF AFFIRMATION OF ENROLLMENT AGREEMENT CORRESPONDENCE COURSE 1. FIRST NAME-MIDDLE INITIAL-LAST NAME OF ELIGIBLE PERSON 3. NAME OF COURSE 4. DATE ENROLLMENT AGREEMENT SIGNED 2. VA FILE NO. 5. NAME AND ADDRESS OF SCHOOL PURPOSE OF THE AFFIRMATION PROVISION OF LAW To provide you time no less than five full days following your signing of an enrollment agreement during which you can reflect on your decision to enroll in a correspondence course and determine if such correspondence course is suitable to your abilities and interests. The Correspondence School Agreement you have signed is not effective unless you complete this form and return it to the school* AFFIRMATION PROCEDURE A. Decision not to Affirm - If you decide not to affirm the Correspondence School Agreement you have signed do not sign this form* Destroy it. Additionally you may notify the institution at any time of your decision not to affirm the enrollment agreement. The institution thereupon without imposing any penalty or fee shall make full refund of all amounts paid* B.

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