Veterans General Information Form (Educational Benefits)
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1VETERANS GENERAL INFORMATION
This information is collected when you first apply for educational benefits or if you are returning after a one year absence from
classes at Louisiana State University in Shreveport.
NAME_____________________________________________ SSN_______________________
First
Middle
Last
MAILING ADDRESS____________________________________________________________
Street or Box #
________________________________________________________________________
City
State
ZIP
TELEPHONE ________________________
LSUS E-MAIL____________________________
(All email will be sent via LSUS student email address)
If this is your FIRST semester to receive educational benefits, you must attach the following documents before certification
can be processed:
Chapter 1606/1607
Application for benefits (VA form 22-1990) or eligibility letter from VA, Notice of Eligibility
(NOBE), Kicker (if you have one), signed curriculum sheet, and a Request for Certification (blue)
form.
Chapter 30
Application for benefits (VA form 22-1990) or eligibility letter from VA, signed curriculum sheet, and
a Request for Certification (blue) form.
Chapter 31
Information from your rehab counselor, signed curriculum sheet, and a Request for Certification (blue)
form
Chapter 33
Application for benefits (VA form 22-1990) or eligibility letter from VA, signed curriculum sheet, and
a Request for Certification (blue) form.
Chapter 35
Application for benefits (VA form 22-5490) or eligibility letter from VA, signed curriculum sheet, and
a Request for Certification (blue) form.
Name of Sponsor________________________________ VA Claim #______________________
Direct Deposit can be processed at 1-800-827-1000 also. Currently Ch. 35 is ineligible for direct deposit.
List all colleges/institutions you have attended:
Name of College/Institution
Dates of attendance
Did you receive VA
Degree/Diploma
benefits while there
LSUS certifies enrollment and attendance ONLY for courses which appear on your approved course outline signed by you and
your adviser and on file with the VA Certifying Official. The department chair from which you are seeking your degree must
approve any substitution. When you change your major, you must complete another VA form and turn in your new
signed curriculum sheet to the VA Certifying Official.
You must complete an Enrollment Certification Request EACH semester for Certification of
Benefits.
___________________________________________________
____________________________________
Student’s Signature
Date
Revised 10/12/2009
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