Submit this form by mailing it to the appropriate VA Regional Processing Office. Ensure to include all required attachments, such as test results and receipts, for optimal processing. For specific mailing addresses, refer to the guidance provided in the form.

This form is valid until 02/28/2025, with the latest approval from the OMB. Always check for updates to ensure compliance and eligibility for reimbursement of test fees.

The purpose of this form is to allow veterans and eligible individuals to seek reimbursement for licensing and certification test fees incurred during their pursuit of further education or certification. By providing necessary personal and test-related information, users can apply for financial assistance through VA education benefits. This process is vital for ensuring that veterans have the resources to advance their professional qualifications without financial strain.

• 1. Applicant Name: Your full name as it appears on official documentation.
• 2. Mailing Address: Your current address for correspondence.
• 3. Email Address: Your valid email for communication purposes.
• 4. VA File Number: Your VA file number if applicable.
• 5. Telephone Number: Your contact number for follow-up inquiries.
• 6. Test Name: The specific name of the test taken for licensing.
• 7. Organization Address: Mailing address of the organization issuing the certification.
• 8. Test Date: The date on which the test was taken.
• 9. Test Results: Results from the test, attached as necessary.
• 10. Cost of Test: Total cost incurred for the test, including fees.
• 11. Signature: Signature of the applicant for authorization.
• 12. Date Signed: Date the application was signed.

Failure to submit this form may result in delayed or denied reimbursement for your test fees. It is crucial to complete and send the form with all required attachments promptly. Incomplete submissions can lead to additional follow-up inquiries and extended processing times.

• Delay in Reimbursement: Incomplete information may slow down the processing of your request.
• Denial of Benefits: Missing critical documentation could result in denial of your claim.
• Increased Workload: Failed submissions may require additional communication with the VA, increasing workload.

• 1. Graduates Seeking Licensure: Recent graduates pursuing licensure in their professional field.
• 2. Career Transitioning Veterans: Veterans switching careers requiring certifications.
• 3. Professional Advancement: Individuals looking to gain additional certifications for career growth.
• 4. Test Fee Reimbursement: Reimbursement for those who have already paid for tests upfront.
• 5. Dependents Applying for Benefits: Dependents of veterans needing reimbursement for their test fees.