CSM VA Intake Form

CSM VA Education Benefits Intake Form
Name*

First NameLast Name
Email*
example@example.com
Student ID Number
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Phone Number*
Please enter a valid phone number.
Please select your intended program of study *
Which of the following describes you? Check all that apply.*

VeteranActive-Duty Service Member, National Guard Member, or Member of the ReservesSpouse of Active-Duty Service MemberSpouse of VeteranChild of VeteranChild of an Active-Duty Service Member

Branch of Service
Please read the following options and select the benefit you will be using

I am a guest student at CSMChapter 33 Post 9/11 GI Bill (Veterans)Chapter 33 Post 9/11 GI Bill (Transfer of Entitlement)Chapter 31 Vocational Readiness and EmploymentChapter 35 Survivors and Dependents Education Assistance ProgramTuition Assistance through a particular branch of the Armed ForcesMyCAA (My Career Advancement Account)I am not sure what benefit I am eligible forI am not using a military benefit at this time

Please upload the VA Form 22-1990/1995 or your Certificate of Eligibility

Cancelof
Please upload DD-214, Certificate of Eligibility and Parent School Letter

Cancelof
Please upload VA Form 22-5490/5495, or Certificate of Eligibility

Cancelof
Service Members First/Last Name
Servicemembers SSN for VA processing
Please upload the VA Form 22-1990e, DOD Transfer of Entitlement, or Certificate of Eligibility

Cancelof
Request MyCAA educational training plan by checking the box below.
Have you met with the VR&E counselor

YesNo
Tuition Assistance Service Approved Document

Cancelof
If you do not know which VA Education Benefit type you will be using please contact our office at veteransbenefits@csmd.edu
If you are not using benefits at this time please contact our office at veteransbenefits@csmd.edu
Please provide your VR&E Counselor Full Name
Please provide your VR&E Counselors Email

CSM VA Education Benefits Intake Form