Summer 2021 CVMF EV form
This form is used to confirm permission by the VA educational benefit recipient to process certification and utilize VA educational benefits to the VA for the spring of 2020.
Email *
RMU email address: *
Last name: *
First name: *
6 digit student ID# (you can find this on your schedule, financial statement, or in Sentry): *
Last 4 of your SS#: *
Please provide the following information (phone number, street address, city, state and zip code) if YOU ARE A NEW RMU STUDENT, A RETURNING RMU STUDENT BUT USING VA EDUCATIONAL BENEFITS FOR THE FIRST TIME, OR IF YOUR CONTACT INFORMATION HAS CHANGED, otherwise enter N/A. *
Please check only ONE of the following school terms for which this form applies: *
Please check the degree status you are working toward: *
Please let us know about your health insurance coverage by selecting one of the following. If you are using your own health insurance you MUST opt out of RMU's health coverage every academic year, please go to: and provide your insurance information. *
Please check the entitlement chapter this form is for: *
Please select any additional benefits you are receiving. Select none if you are not receiving any of the following: *
Are you a transfer of educational benefits student (TEB)? *
If yes, please indicate who transferred benefits to you. Check N/A if not applicable: *
Please list your branch of service. Enter N/A if you are a TEB: *
Please check if you are currently on active duty: *
List any courses that you are repeating from a previous term or semester, enter N/A if not applicable: *
Please check the box if you would like the CVMF to certify all scheduled courses to the VA. Please make sure you understand how your scheduled courses impact your MHA benefits: *
By typing your name in full and date you are authorizing the CVMF to certify your scheduled courses to the VA, utilizing your VA educational benefits: *
A copy of your responses will be emailed to the address you provided.
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