OMB Control No. 2900-0074
Respondent Burden: 20 minutes
REQUEST FOR CHANGE OF PROGRAM OR PLACE OF TRAINING
PART I - IDENTIFICATION AND PERSONAL INFORMATION
1A. NAME OF APPLICANT (First, Middle, Last)
VA DATE STAMP
DO NOT WRITE IN THIS SPACE
1B. MAILING ADDRESS (Complete street address, City, State, and 9-digit ZIP Code)
1C. APPLICANT'S TELEPHONE NUMBER (Including Area Code)
DAY
1D. VA FILE NUMBER
EVENING
1F. SOCIAL SECURITY OF APPLICANT (For transferability cases,
enter the veteran's social security number)
1E. APPLICANT'S E-MAIL ADDRESS
PART II - YOUR PROGRAM INFORMATION
2. EDUCATION BENEFIT YOU WANT TO RECEIVE (Only Select One)
A.
B.
CHAPTER 33 (Post-9/11 GI BILL)
C.
CHAPTER 32 (Veterans Educational Assistance
Program including section 903)
E.
CHAPTER 1607 (Reserve Educational
Assistance Program)
CHAPTER 30 (Montgomery GI Bill - Active
D.
CHAPTER 1606 (Montgomery GI BillSelected Reserve)
F.
TRANSFER OF ENTITLEMENT PROGRAM
Duty)
3. HOW WILL YOU TAKE TRAINING?
A.
SCHOOL ATTENDANCE
D.
B.
CORRESPONDENCE
E.
COOPERATIVE TRAINING
G.
LICENSING & CERTIFICATION TEST
TUITION ASSISTANCE TOP-UP
H.
NATIONAL ADMISSIONS EXAMS OR
NATIONAL EXAMS FOR CREDIT
(Active Duty Only)
C.
APPRENTICESHIP OR ON-THE-JOB TRAINING
F.
FLIGHT TRAINING
4A. WHAT EDUCATION, PROFESSIONAL OR VOCATIONAL GOAL ARE
YOU WORKING TOWARD?
4B. WHAT IS THE NAME OF THE PROGRAM YOU ARE REQUESTING?
4C. IF CHANGING SCHOOLS, GIVE NAME AND COMPLETE ADDRESS OF
NEW SCHOOL OR TRAINING ESTABLISHMENT YOU ARE PLANNING
TO ATTEND (If applicable)
4D. NAME AND COMPLETE ADDRESS OF OLD OR CURRENT SCHOOL OR
TRAINING ESTABLISHMENT
4E. TELL US WHEN AND WHY YOU STOPPED TRAINING AT YOUR PRIOR SCHOOL OR ESTABLISHMENT. CONTINUE IN REMARKS, ITEM 10, OR ON A SEPARATE
SHEET IF NECESSARY.
PART III - DIRECT DEPOSIT INFORMATION
5. DIRECT DEPOSIT INFORMATION (Complete this item only if you wish to...