Va Form 22-0803 - Application For Reimbursement Of Licensing Or Certification Test Fees
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2OMB Approved No. 2900-0695
Respondent Burden: 15 Minutes
Expiration Date: 3/31/2018
APPLICATION FOR REIMBURSEMENT OF LICENSING OR
CERTIFICATION TEST FEES
IMPORTANT: Complete this application to apply for reimbursement of licensing or certification test fees. You must apply separately for VA
education benefits if you have not already done so. You can receive reimbursement of a licensing or certification test fee if you qualify for VA
benefits under one of the following programs:
Montgomery GI Bill - Active Duty Educational Assistance Program (MGIB) (Chapter 30)
Post-Vietnam Era Veterans Educational Assistance Program (VEAP) (Chapter 32)
Post-9/11 GI Bill (Chapter 33)
Survivors' and Dependents' Educational Assistance Program (DEA) (Chapter 35)
Montgomery GI Bill - Selected Reserve Program (MGIB-SR) (Chapter 1606)
Reserve Educational Assistance Program (REAP) (Chapter 1607)
(See the reverse for Information and Instructions for completing this form.)
PART I - IDENTIFICATION INFORMATION
1. NAME OF APPLICANT (First, Middle Initial, Last Name)
2. MAILING ADDRESS OF APPLICANT (Number and street or rural route, city or P. O., State and ZIP Code)
3. VA FILE NUMBER (For chapter 35, enter the veteran's file number. Be
4. SOCIAL SECURITY NUMBER (If not shown in Item 3.)
sure to include the suffix indicator. For dependent transfer cases, enter
the file number of the person who transferred entitlement to you.)
5. TELEPHONE NUMBER AND HOURS VA CAN REACH YOU
(Include Area Code)
6. VA EDUCATION INFORMATION
A. HAVE YOU PREVIOUSLY APPLIED FOR VA EDUCATION BENEFITS?
YES
NO
(If "Yes," show the specific benefit you previously applied for in Item 6B.)
(If "No," you should complete an application for education benefits.)
B. WHAT EDUCATION BENEFIT HAVE YOU APPLIED FOR PREVIOUSLY?
C. WHAT EDUCATION BENEFIT ARE YOU APPLYING FOR NOW?
CHAPTER 30
CHAPTER 32
CHAPTER 33
CHAPTER 35
CHAPTER 1606
CHAPTER 1607
PART II - TEST INFORMATION
7. NAME OF TEST (Specify for each test) (If more space is needed use Item
8. COMPLETE NAME AND MAILING ADDRESS OF ORGANIZATION
11 Remarks.)
ISSUING LICENSE OR CERTIFICATION (Specify for each test.)
9. DATE TEST TAKEN AND TEST RESULTS (See the Instructions for this
item for information and evidence you must specify or attach to this
application.) (If more space is needed, use Item 11 Remarks.)
10. COST OF TEST INCLUDING MANDATORY FEES (Specify for
each test) (If more space is needed use Item 11 Remarks)
11. REMARKS
I hereby authorize the release of my test information to the Department of Veterans Affairs (VA).
12. SIGNATURE OF APPLICANT
13. DATE SIGNED
IMPORTANT: To apply for reimbursement of a licensing or certification test fee, please return this form to the VA office which handles your area.
See the addresses on page 2 of this form. Include a copy of your test results.
VA FORM
22-0803
SUPERSEDES VA FORM 22-0803, MAR 2015,
Page 1
DEC 2016
WHICH WILL NOT BE USED.
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