VA Personal Data Sheet
(Students using VA Education Benefits)
Student ID
*
Date of Birth
*
-
Month
-
Day
Year
Date
Name
*
First Name
Middle Name
Last Name
Mailing Address
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Primary Phone
*
Please enter a valid phone number.
Format: (000) 000-0000.
Alternate Phone
Please enter a valid phone number.
Format: (000) 000-0000.
Personal 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 31 (Veteran Readiness & Employment – VR&E)
Chapter 33 Students (Dependents Only)
If you are a dependent of the Veteran and using Ch. 33 benefits, please provide the following:
Veteran's Name
First Name
Last Name
Chapter 35 Students
Please provide the following:
Veteran's Name
First Name
Last Name
Chapter 31 Students
Please provide the following:
VR&E Counselor's Name
First Name
Last Name
VR&E Counselor's Phone
Please enter a valid phone number.
Format: (000) 000-0000.
VR&E Counselor's Email
example@example.com
Previous College(s) Attended:
Submit
Should be Empty: