CSM VA Education Benefits Intake Form
Name
*
First Name
Last Name
Email
*
example@example.com
Student ID Number
Address
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Phone Number
*
Please enter a valid phone number.
Please select your intended program of study
*
Please Select
ACCOUNTING-AAS
ARTS AND SCIENCES-AA
BUSINESS ADMINISTRATION-AS
BUSINESS MANAGEMENT-AAS
CLOUD AND INFORMATION TECHNOLOGY-AAS
COMPUTER ENGINEERING-ASE
COMPUTER SCIENCE-AS
CONSTRUCTION MANAGEMENT-AAS
CYBERSECURITY-AAS
DIGITAL MEDIA PRODUCTION-AA
EARLY CHILDHOOD DEVELOPMENT-AAS
EARLY CHILDHOOD EDUCATION-AAT
ELECTRIC POWER TECHNICIAN-AAS
ELECTRIC WIRING TECHNICIAN-AAS
ELECTRICAL ENGINEERING-ASE
ELEMENTARY EDUCATION-GENERIC SPECIAL-AAT
EMERGENCY MEDICAL SERVICES-AAS
ENERGY SYSTEMS TECHNOLOGY-AAS
ENGINEERING TECHNOLOGY-AAS
ENGINEERING-AS
ENVIRONMENTAL STUDIES-AS
FIRE SAFETY TECHNOLOGY-AAS
GENERAL STUDIES-AA
HEALTH INFORMATION MANAGEMENT-AAS
HOMELAND SECURITY-AAS
HOSPITALITY MANAGEMENT-AAS
HUMAN SERVICES-AAS
INFORMATION SERVICES TECHNOLOGY-AAS
INFORMATION SYSTEMS-AAS
INFORMATION SYSTEMS-ENGINEERING TECH-AAS
LAW ENFORCEMENT-AAS
MARITIME OPERATIONS TECHNOLOGY-AAS
MASSAGE THERAPY-AAS
MATHEMATICS AND SCIENCES-AS
MEDICAL LABORATORY TECHNOLOGY-AAS
NUCLEAR MEDICINE TECHNOLOGY-AAS
NURSING-AS
PHOTOGRAPHY-AAS
PHYSICAL THERAPY ASSISTANT-AAS
PRE-PROFESSIONAL HEALTH SCIENCE-AS
SOFTWARE DEVELOPMENT-AAS
SPORTS MANAGEMENT-AS
TEACHER EDUCATION-AA
CERT-LDC-ACCOUNTING-ADVANCED
CERT-LDC-ACCOUNTING-BASIC
CERT-LDC-ADVANCED THERAPEUTIC MASSAGE-TO
CERT-LDC-BASIC THERAPEUTIC MASSAGE-TEACH
CERT-LDC-BUSINESS ANALYSIS
CERT-LDC-BUSINESS MANAGEMENT
CERT-LDC-COMMERCIAL VEHICLE OPERATOR
CERT-LDC-CONSTRUCTION MANAGEMENT
CERT-LDC-CRIMINAL JUSTICE
CERT-LDC-CYBERSECURITY
CERT-LDC-DRAFTING
CERT-LDC-EARLY CHILDHOOD DEVELOPMENT
CERT-LDC-ELECTRONICS TECHNOLOGY
CERT-LDC-EMERGENCY MED SERV PARAMEDICS
CERT-LDC-ENGINEERING TECHNOLOGY
CERT-LDC-FITNESS MANAGER-ADVANCED
CERT-LDC-FITNESS MANAGER-BASIC
CERT-LDC-GRAPHIC DESIGN
CERT-LDC-HUMAN SERVICES MENTAL HEALTH
CERT-LDC-INFORMATION SYSTEMS
CERT-LDC-MEDICAL ASSISTING
CERT-LDC-MEDICAL CODING SPECIALIST
CERT-LDC-OFFICE TECHNOLOGIES-TEACHOUT
CERT-LDC-PHARMACY TECHNICIAN
CERT-LDC-PHOTOGRAPHY
CERT-LDC-PRACTICAL NURSING
CERT-LDC-RETAIL MANAGEMENT
CERT-LDC-ROBOTICS
CERT-LDC-SECURITY MANAGEMENT
CERT-LDC-SMALL BUSINESS AND
CERT-LDC-TECHNICAL SUPPORT
CERT-LOR-BUSINESS MANAGEMENT
CERT-LOR-CRIMINAL JUSTICE
CERT-LOR-OFFICE TECHNOLOGY-TEACHOUT
CERT-LOR-ROBOTICS
CERT-LOR-SECURITY MANAGEMENT
CERT-LOR-SMALL BUSINESS AND
CERTIFIED GERIATRIC NURSING ASSISTANT
CLINICAL MEDICAL ASSISTANT
COMMERCIAL TRUCK DRIVING CLASS A-CED
COMMERCIAL TRUCK DRIVING CLASS A-CED-
ELECTRICAL HELPER CERT EVENING
ELECTRICAL HELPER CERTIFICATE
HVAC HELPER CERTIFICATE
HVAC HELPER CERTIFICATE-EVENING
NETWORK ADMINISTRATOR
REAL ESTATE SALES LICENSE-CH31 ONLY
Which of the following describes you? Check all that apply.
*
Veteran
Active-Duty Service Member, National Guard Member, or Member of the Reserves
Spouse of Active-Duty Service Member
Spouse of Veteran
Child of Veteran
Child of an Active-Duty Service Member
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Next
Please read the following options and select the benefit you will be using
I am a guest student at CSM
Chapter 33 Post 9/11 GI Bill (Veterans)
Chapter 33 Post 9/11 GI Bill (Transfer of Entitlement)
Chapter 31 Vocational Readiness and Employment
Chapter 35 Survivors and Dependents Education Assistance Program
Tuition Assistance through a particular branch of the Armed Forces
MyCAA (My Career Advancement Account)
I am not sure what benefit I am eligible for
I am not using a military benefit at this time
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Next
Please upload the VA Form 22-1990/1995, DD-214 and Certificate of Eligibility
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Please upload DD-214, Certificate of Eligibility and Parent School Letter
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Please upload VA Form 22-5490/5495, DD-214, and Certificate of Eligibility
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Please upload the VA Form 22-1990e, DOD Transfer of Entitlement, and Certificate of Eligibility
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of
Request MyCAA educational training plan by checking the box below.
Have you met with the VR&E counselor
Yes
No
Tuition Assistance Service Approved Document
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of
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
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Do you have transcripts from other prior college/Universities
Yes
No
Have you ordered JST Transcripts
Yes
No
I do not have JST Transcripts
Additional Comments
Name
First Name
Last Name
Submit
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