VA Student Information Sheet
Name
*
First Name
Middle Name
Last Name
Social Security Number
Student ID
*
Date of Birth
*
-
Month
-
Day
Year
Date
Mailing Address
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Primary Phone
*
Please enter a valid phone number.
Alternate Phone
Please enter a valid phone number.
Email
*
example@example.com
Student Email
*
example@example.com
Major
*
Which chapter of benefits will you be using?
*
Chapter 30 (Montgomery GI Bill ®)
Chapter 33 (Post 9/11 GI Bill ®)
Chapter 35 (Dependents’ Educational Assistance – DEA)
Chapter 1606 (Reserve/National Guard)
Chapter 1607 (Reserve/National Guard – REAP)
Chapter 31 (Veteran Readiness & Employment – VR&E)
Veteran's SSN (if using Chapter 35)
VR&E Counselor's Name, Phone, and Email (if using Chapter 31)
Previous College(s) Attended
Submit
Should be Empty: