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California State University, Long Beach
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Request for Enrollment Certification for VA Benefits

Please complete and submit online, or print, then complete, and return to the CSULB Veterans Services Office.

California State University, Long Beach
1250 Bellflower Boulevard, Brotman Hall 270
Long Beach, California 90840

Your Personal Information
Note: The address submitted on this form must be the same as in your CSULB records. To check or change your address, go to .
Benefits Information
Are you on active duty?
Type of benefits:

Have you used VA benefits before?
Were these benefits last used at CSULB?
If you answered NO to either of the preceding questions, please contact the Veterans Services Office here or call (562) 985-5115.
Degree & Major Information
Degree Objective:
This is the same major you had last semester.
Term Information
Please note: You must submit this form to the CSULB VA Program office each semester. You must promptly notify the CSULB VA Services Office of any change in your class schedule or major. You are responsible for overpayment of benefits.