1.

Name of Student:

VA File Number of Student:

2.

Name and Address of Institution Granting the Award:

          (Degree, Diploma, Certificate)

3.

Student’s Current or Intended Program:

4.

CERTIFICATION

I certify that the above named student:

a.

has applied for admission to this institution or is currently a degree/diploma/certificate seeking student at this institution;

b.

has permission to take the unit course(s) listed below at the institution listed below; and,

c.

that the credits or clock hours for this course(s) also listed below will transfer to this institution and apply in full toward the graduation requirements of this institution or meet the prerequisite requirements for courses that will be taken in this student’s current or proposed program if they have not been officially accepted by this institution.

Name and address of institution

where course(s) will be taken

(non parent institution)

Course Title

Course Code

Credit/Clock Hours

Signature of VA Certifying Official

Title

Date

I give permission to

(parent institution) where I am a degree/diploma candidate to request

an official record of the grades received in the above courses from

(non parent institution).

In giving this permission I agree to the informal calculation of a combined grade point average that will be used to determine the completion of future 315 forms.  Additionally, I agree to follow up on the action created by this release statement to ensure that the grades are submitted to the parent institution in a timely manner so that future VA Enrollment Certification forms can be properly completed on my behalf.  I understand that failure to ensure the timely delivery of the grades may delay the receipt of my VA educational assistance benefits.  I further understand that a “combined GPA” that does not conform to the academic progress standards of the parent institution will prohibit, for VA benefit purposes, the further inclusion of course work taken at other institutions for a full calendar year or the successful completion of 24 credit hours at the parent institution, whichever occurs first, for two-year and longer programs or six months/12 credits for programs that are less than two years in length.

VA Student Signature

Date