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

Do you have transcripts from other prior college/Universities

YesNo
Have you ordered JST Transcripts

YesNoI do not have JST Transcripts
By signing below, you authorize the College of Southern Maryland (CSM) VA Office to access your Joint Services Transcript (JST) account for the purpose of ordering your JST transcripts on your behalf.If you prefer to opt out of this service and do not wish to grant CSM VA Office access to your JST account, please check the box below:

I do not authorize the CSM VA Office to access my JST account.
Additional Comments
Name

First NameLast Name
Should be Empty:

CSM VA Education Benefits Intake Form