Fillable G.i. Bill Enrollment Card Form printable pdf download

G.i. Bill Enrollment Card Form

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G.I. BILL ENROLLMENT CARD

)

(YOU MUST FILL OUT THIS FORM EVERY SEMESTER

__________________________________ ______________________ ___________________

LAST NAME, FIRST NAME MI

SCHOOL EMAIL

PERSON #

___________________________________________________ _________________________

STREET ADDRESS, CITY, STATE ZIP

SOCIAL SECURITY #

(First Time Applicants Only)

PHONE # __________________________

LEVEL IN SCHOOL: UNDERGRAD/GRAD/PROFESSIONAL (Please Circle)

*Number of credits you are taking this semester: ____________ MAJ OR:___________

*YOU MUST NOTIFY US OF ANY CHANGE IN THE NUMBER OF CREDITS YOU ARE

TAKING, OR IF YOU WITHDRAW. IF A POST-911 RECIPIENT, YOU MAY BE

RESPONSIBLE FOR REPAYING MONEY TO THE VA.

Semester and year you want to use benefits: _____________________________________

Continuing Student (have received benefits before): ___________

New Student:_______

Transfer Student:________

BENEFIT PACKAGE (CHECK ONE)

Will you need health insurance

Through UB? Yes/No

________

CH 1606 (GI BILL-RESERVES) _____

(you can waive UB’s health insurance if you

CH 1607 (REAP)

_____

are covered by another insurer. You must

CH 30 (GI-BILL ACTIVE)

_____

provide proof to the student health insur-

CH 31 (VOC REHAB)

_____

ance office).

CH 35 (CHILD/SPOUSE)

_____

VA # ________________

NY STATE RESIDENT? ___________

(different from student SS#)

Are you receiving any other tuition based

grants, scholarships? Yes/No ___________

CH 33 POST 911 only : _________

If yes, please list below (TAP, VTA):

What percentage of the GI BILL

__________________

Benefits are you eligible for? _________

Are you a dependent? ___________

If you are receiving 100% post 911 benefits

(Chapter 33), and are in-state, any other tui-

tion based award is considered a duplica-

tion of benefits. You will only receive money

to cover tuition, not exceed it.

DATE RECEIVED: _________________

University at Buffalo,Veteran Services, 101 Allen Hall, Buffalo, NY 14214, (716) 645-2271, ub-vets@buffalo.edu

G.i. Bill Enrollment Card Form

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