Application For Work-Study Allowance

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OMB Approved No. 2900-0209
Respondent Burden: 15 minutes
APPLICATION FOR WORK-STUDY ALLOWANCE
PART I - IDENTIFICATION INFORMATION
(First, Middle, Last)
1. NAME OF APPLICANT
(Number, and street or rural route, city or
(For chapter 35, enter the veteran's file number.
2. MAILING ADDRESS OF APPLICANT
3A. VA FILE NUMBER
P.O., State and 9 digit ZIP Code)
Be sure to include the suffix indicator. For dependent's transfer of
entitlement cases, enter the file number of the person who transferred
entitlement to you)
(If not shown in Item 3A)
3B. SOCIAL SECURITY NUMBER
3D. SEX OF APPLICANT
MALE
FEMALE
(Month, Day, Year)
3C. DATE OF BIRTH OF APPLICANT
4B. PLEASE PROVIDE THE HOURS THAT VA CAN REACH YOU
(Include Area Code)
DAYTIME
EVENING
4A. TELEPHONE NUMBER
5. EDUCATION BENEFIT RECEIVING
(Post- 9/11 GI Bill)
CHAPTER 33
(Montgomery GI Bill - Active Duty)
(Dependents Educational Assistance)
TRANSFER OF ENTITLEMENT
CHAPTER 30
CHAPTER 35
(Parent or Spouse
PROGRAM
(Vocational Rehabilitation)
(Montgomery GI Bill - Selected Reserve)
CHAPTER 31
CHAPTER 1606
entitled to benefits)
(Veterans Educational Assistance Program)
(Reserve Educational Assistance Program)
CHAPTER 32
CHAPTER 1607
PART II - SCHOOL INFORMATION
6A. NAME AND COMPLETE ADDRESS OF SCHOOL
6B. CURRENT ACADEMIC OR TRAINING PROGRAM
7. CURRENT ENROLLMENT INFORMATION
8. NEXT ENROLLMENT PERIOD YOU PLAN TO ATTEND
A. BEGINNING DATE
B. ENDING DATE
A. BEGINNING DATE
B. ENDING DATE
(Month, Day, Year)
(Month, Day, Year)
(Month, Day, Year)
(Month, Day, Year)
PART III - WORK STUDY INFORMATION
9. ADVANCE PAYMENT - DO YOU WANT AN ADVANCE PAYMENT? (See instructions for information on advance payment on reverse under
"How Much Can I Earn?")
YES
NO
(Tell us the school, VA facility or other government
10. HAVE YOU EVER PARTICIPATED IN THE VA WORK-STUDY
11. WORK SITE PREFERENCE
facility where you would prefer to do VA related work. Be specific as many facilities
(If "YES," please state where you worked)
PROGRAM BEFORE?
have the same name or perform the same services in different locations or cities.)
YES
NO
(Tell us about the jobs you had before,
12. WORK EXPERIENCE
13. SPECIFY THE DAYS AND HOURS DURING THE WEEK YOU ARE AVAILABLE TO WORK
other than VA work-study jobs. Please be as specific as possible.
(X)
DAYS
WHEN AVAILABLE (From & To)
If you have no work experience, place "NONE" in this space. If
needed, attach a separate sheet with your work-history)
MONDAY
TUESDAY
WEDNESDAY
THURSDAY
FRIDAY
(Tell us about any special qualifications you have based on your education or work experience. Include any experience in information
14. QUALIFICATIONS
technology. Also, tell us what kinds of jobs interest you. If needed, attach a separate sheet with this information)
(Do not print)
16. DATE SIGNED
15. SIGNATURE OF APPLICANT
PRIVACY ACT INFORMATION: VA will not disclose information collected by this information collection to any source other than what has been authorized by the Privacy Act of 1974 or
Title 38 Code of Federal Regulations 1.576 for routine uses as identified in VA's system of records, 58 VA 21/22/28, Compensation, Pension, Education and Vocational Rehabilitation Records -
VA as published in the Federal Register at An example of a routine use allows VA to send educational forms or letters with a veteran's
identifying information to the veteran's school or training establishment to (1) assist the veteran in the completion of claims forms or (2) for VA to obtain further information as may be necessary
from the school for VA to properly process the veteran's education claim or to monitor his or her progress during training. Your obligation to respond is "required to obtain or retain benefits". We
cannot pay you any work-study benefits until we receive this information (38 U.S.C. 3485). Your responses are confidential (38 U.S.C. 5701). Any information provided by applicants may be
subject to verification through computer matching programs with other agencies.
Respondent Burden: We need this information to determine your eligibility for VA work-study benefits. Title 38 United States Code allows us to ask for this information. We estimate that you
will need an average of 15 minutes to review the instructions, find the information, and complete the form. VA cannot conduct or sponsor a collection of information unless a valid OMB control
number is displayed. You are not required to respond to a collection of information if this number is not displayed. Valid OMB control numbers can be located on the OMB Internet page at
If desired, you can call 1-888-GI-BILL-1 (1-888-442-4551) to get information on where to send comments or suggestions about
this information collection.
VA FORM
22-8691
EXISTING STOCKS OF VA FORM 22-8691, MAR 2009,
JUL 2012
WILL NOT BE USED.

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