First Name: Middle Name: Last Name: Student ID Number: Mailing Address: The VA may use this address to contact you. City: State: Zip: E-mail: Branch of Service: Optional Unit: Residency Status: In-state, out-of-state, WUE, etc. You must apply @ www.gibill.va.gov in order to start your benefits – this is a one-time application.
This Student Info Sheet informs the university that you will be using benefits – this form is updated annually.
If you have used benefits before at a different school or changed your major, fill out a VA Form 22-1995
(or Form 22-5495 for Ch. 35) before your benefits can be processed.
Status: Which GI Bill do you use?:
Chapter 31s must contact the Veterans Services Office.
Additional Information: Please provide any additional information on your GI Bill including the number of years for Chapter 30, What % for Chapter 33 and survivor or dependent for Chapter 35.
Do you have any kickers?: If 'Yes,' how much?: Will you be receiving any tuition assistance from your Active Duty, Guard,Reserve Unit? : Active Duty?: Will you be on Active Duty during the term? Anticipated Enrollment Degree Sought at USD: Anticipated graduation date: mm/yy Major:
I have recently added or changed a major and/or minor. VA Form 1995 or 5495 must be submitted.
I am a recent transfer student who has used VA education money at another school. VA Form 1995 or 5495 must be submitted. The number of hours I plan to enroll in for Fall 2012: The number of hours I plan to enroll in for Summer 2012: The number of hours I plan to enroll in for Spring 2012: The number of hours I plan to enroll in for Spring 2013: Will you be taking any online classes?: Will you be taking any classes at other schools?: If so, you must notify the Veteran's Services Office each term.
I hereby acknowledge that I will notify Veterans’ Services of all courses I take that do not satisfy a
requirement in my degree program since the VA will not pay for these classes (ex. extra electives,
repeating a passed course). If I drop, add, or withdrawal from a class I must inform Vet’s office to avoid
any overpayments or non-payments. All benefits other than Tuition & Fees will be paid directly to me.
I have read and understand all of the above information and have received a copy of the:
Once submitted by the certifying official to the VA, first
time education benefits will be processed in 6-12 weeks, recurring benefits may be processed sooner.