Request For Gi Bill Benefits Form

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Request for GI Bill Benefits Form
SUMMER (year): _____________
(To be submitted every semester)
MassBay Office of Veterans’ Affairs
Date Submitted: _____________
Name: _____________________________________________ MassBay Student ID#: ___________________________
DO NOT SUBMIT THIS UNTIL YOU REGISTER FOR CLASSES & HAVE ENTIRELY COMPLETED THIS FORM
Are you currently on ‘active duty’?
Yes
No
Did you apply for/receive Federal Financial Aid?
Submitted FAFSA
Granted Financial Aid
Are you currently Mass. National Guard?
Yes
No
If Yes – attach your Certificate of Eligibility for correct # of credits
What VA education benefits are you applying for:
(choose only one)
Chapter 31 (Voc. Rehab.)
VETERAN
Chapter 33 (Post-9/11
)
Chapter 1606 (Sel. Guard/Reserve)
Chapter 30 (Veteran)
Chapter 33 Transfer of Entitlement
Chapter 1607 (REAP)
Chapter 35 (Dependent)
MA Veterans’ Tuition
Waiver only
Dependent
(Post-9/11
)
If Post 9/11 GI Bill – attach your most current letter of eligibility or eBenefits printout to this form.
If Voc. Rehab. – attach VA Form 28-1905 to this form.
LAST Name
FIRST Name
M.I.
Address
City
State
Zip
(include apt)
E-mail
Cell Phone #
Alternate Phone #
(one that you check daily please)
nd
Major
2
Major
Degree
(if applicable)
(i.e. AS, AA or Cert)
Expected graduation:
Year:
_____________
May
December
I am a:
New Freshman Student
Continuing MassBay Student
New Transfer Student
Readmitted Student (after 2 or more semesters of absence)
YOU MUST BE REGISTERED FOR CLASSES BEFORE CERTIFICATION REQUESTS CAN BE SUBMITTED to the VA
SEMESTER to be certified: SUMMER (Year): _________
st
nd
1
6-week term
2
6-week term
10 week term
_______
_______
# of Credits in class:
# of Credits in class:
_______
# of Credits in class:
_______
_______
_______
# of Credits online:
# of Credits online:
# of Credits online:
Class Schedule must be attached
_____________________________________
Are you repeating any courses?
Which course(s):
Yes
No
_____________________________________
____________________________________
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