Veterans Education Benefits Request Form

GI Bill® is a registered trademark of the U.S. Department of Veterans Affairs (VA). More information about education benefits offered by VA is available at the official U.S. Government website at at https://www.benefits.va.gov/gibill

Name*

First Name

Last Name

Student ID *

Email Address*

Phone Number*

Program/Major

Semester*

Fall Winter Spring Summer

Year*

Have you received VA Benefits at West Valley before?*

Yes No

Are you currently enrolled at another college?*

Yes No

Do you plan on applying for Financial Aid?*

Yes No

Are you the dependent of a Veteran, receiving transferred benefits?*

Yes No

Type of VA Educational Benefits*

Chapter 30 Montgomery GI Bill® Chapter 31 Vocational Rehabilitation Chapter 33 POST 9/11 GI Bill® Chapter 35 Survivors and Dependents Chapter 1606 Montgomery Reservists

Other:

Please specify the number of units you plan to enroll in.*

I am requesting educational benefits and I understand that I will only receive benefits for the courses listed on my Veteran’s Ed-Plan.*

I agree I disagree

Further, I will notify the Financial Aid Office of any changes (i.e. unit’s courses, Failing grades, phone number etc.) that may affect my educational benefits. Failure to do so may jeopardize my receipt of benefits and/ or create an over payment to the Veterans Affairs.*

I agree I disagree

Signature

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