Application for VA Education Benefits

Application for VA Education Benefits (VA Form 22-1990)

Department of Veterans Affairs

Use this form to apply for educational assistance under the following benefit programs:

• Post-9/11 GI Bill chapter 33 of title 38, U.S. Code
• Montgomery GI Bill (MGIB) chapter 30 of title 38, U.S. Code
• Montgomery GI Bill - Selected Reserve (MGIB-SR) chapter 1606 of title 10, U.S. Code
• Reserve Educational Assistance Program (REAP) chapter 1607 of title 10, U.S. Code
• Post-Vietnam Era Veterans' Educational Assistance Program (VEAP) chapter 32 of title 38, U.S. Code, or section 901 or section 903 of Public Law 96-342

PART I - APPLICANT INFORMATION

1. Social Security Number of Applicant:

2. Sex of Applicant: Male Female

3. Applicant's Date of Birth:

4. Name (First, Middle Initial, Last):

5. Applicant's Address:

Number and Street:

Apt/Unit Number:

City, State, ZIP Code:

6A. Applicant's Telephone Numbers (Include Area Code):

Primary: Secondary:

6B. Applicant's E-mail Address:

7. Direct Deposit (Attach a voided personal check or provide the following information. Direct Deposit is not available for VEAP)

Routing or Transit Number: Account Type: Checking Savings

Account Number:

8. Please provide the name, address, and phone number of someone who will always know where you can be reached

PART II - EDUCATION BENEFIT BEING APPLIED FOR

9A. Chapter 33 - Post-9/11 GI Bill

9B. Chapter 30 - Montgomery GI Bill Educational Assistance Program (MGIB)

9C. Chapter 1606 - Montgomery GI Bill - Selected Reserve Educational Assistance Program (MGIB-SR)

9D. Chapter 1607 - Reserve Educational Assistance Program (REAP)

9E. Chapter 32 or Section 903 - Post-Vietnam Era Veterans' Educational Assistance Program (VEAP)

9F. Chapter 33 Election (Complete only if this is your first request for chapter 33 and you are eligible for one of the benefits listed below)

I elect to receive chapter 33 education benefits in lieu of the education benefit checked below, effective
I understand that my election is irrevocable and may not be changed. (Check only one)

Chapter 30 - Montgomery GI Bill Educational Assistance Program (MGIB)

Chapter 1607 - Reserve Educational Assistance Program (REAP)

Chapter 1606 - Montgomery GI Bill - Selected Reserve Educational Assistance Program (MGIB-SR)

PART III - TYPE AND PROGRAM OF EDUCATION OR TRAINING

10A. Type of Education or Training:

10B. Provide the full name and address of the school, if known:

10C. Please specify your educational or career objective, if known:

PART IV - SERVICE INFORMATION

11. Are you now on active duty? Yes No

12. Are you now on terminal leave just before discharge? Yes No

13. Please complete the following for each period of military service:

14A. Did you receive a high school diploma or high school equivalency certificate? Yes No Date:

14B. Do you hold any FAA flight certificates? Yes No

14C. Education after high school:

14D. Employment (Only complete if you held a license or journeyman rating to practice a profession):

PART VI - ENTITLEMENT TO AND USAGE OF ADDITIONAL TYPES OF ASSISTANCE

15. Did you make additional contributions (up to $600.00) to increase the amount of your monthly benefits? Yes No

16. Do you qualify for a kicker (sometimes called a "College Fund") based on your military service? Yes No

Active Duty Kicker: Yes No Reserve Kicker: Yes No

17. If you graduated from a military service academy, specify the year you graduated and received your commission:

18. Were you commissioned as the result of a Senior ROTC scholarship? Yes No

19. Are you currently participating in a Senior ROTC scholarship program that pays for your tuition, fees, books and supplies? Yes No

20. If you had a period of active duty that the Department of Defense counts for purposes of repaying an education loan, check yes: Yes No

21. For active duty claimants only: Are you receiving, or do you anticipate receiving, any money from the Armed Forces or Public Health Service for the course? Yes No

22. For civilian employees of the U.S. Government only: Are you receiving, or do you anticipate receiving, any money from your agency for the same period? Yes No

PART VII - INFORMATION ON VA EDUCATION BENEFITS

If you would like to receive a printed pamphlet check here:

PART VIII - MARITAL AND DEPENDENCY STATUS

22. Are you married? Yes No

23. Do you have any children who are under age 18, or over 18 but under age 23, not married and attending school, or of any age permanently helpless for mental or physical reasons? Yes No

24. Do you have a parent who is dependent upon you for financial support? Yes No

PART IX - REMARKS

PART X - CERTIFICATION AND SIGNATURE OF APPLICANT

I certify that all statements in my application are true and correct to the best of my knowledge and belief. If on active duty, I also certify that I have consulted with an Education Service Officer (ESO) regarding my education program.

Penalty - Willful false statements as to a material fact in a claim for education benefits is a punishable offense and may result in the forfeiture of these or other benefits and in criminal penalties.