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Get VA 28-1905 2002

CERTIFICATION OF STATUS NOTE: Before completing this form, read the instructions and other important information on the back. SECTION A - IDENTIFYING DATA 1. NAME AND MAILING ADDRESS OF ENTITLED INDIVIDUAL 2. VA FILE NUMBER . . 3. SOCIAL SECURITY NUMBER SECTION B - AUTHORIZATION TO FACILITY/VENDOR 4. NAME OF SERVICE/ASSISTANCE (Include degree type when applicable) 5. ENROLLMENT PERIOD 6. PLAN CODE 7. FACILITY CODE 8. NAME AND ADDRESS OF FACILITY OR SERVICE PROVIDER (Vendor) 9. SPECIFIC.

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