OMB Control No. 2900-0074
Respondent Burden: 20 Minutes
Expiration Date: 03/31/2015
REQUEST FOR CHANGE OF PROGRAM OR PLACE OF TRAINING
PART I - IDENTIFICATION AND PERSONAL INFORMATION
(First, Middle, Last)
VA DATE STAMP
1A. NAME OF APPLICANT
DO NOT WRITE IN THIS SPACE
(Complete street address, City, State, and 9-digit ZIP Code)
1B. MAILING ADDRESS
(Including Area Code)
1D. VA FILE NUMBER
1C. APPLICANT'S TELEPHONE NUMBER
EVENING
DAY
(For transferability cases,
1F. SOCIAL SECURITY OF APPLICANT
enter the veteran's social security number)
1E. APPLICANT'S E-MAIL ADDRESS
PART II - YOUR PROGRAM INFORMATION
(Only Select One)
2. EDUCATION BENEFIT YOU WANT TO RECEIVE
(Veterans Educational Assistance
(Reserve Educational
CHAPTER 32
CHAPTER 1607
(Post-9/11 GI BILL)
A.
C.
E.
CHAPTER 33
Program including section 903)
Assistance Program)
(Montgomery GI Bill -
(Montgomery GI Bill-
CHAPTER 30
CHAPTER 1606
B.
D.
F.
TRANSFER OF ENTITLEMENT PROGRAM
Active Duty)
Selected Reserve)
3. HOW WILL YOU TAKE TRAINING?
A.
SCHOOL ATTENDANCE
D.
COOPERATIVE TRAINING
G.
LICENSING & CERTIFICATION TEST
NATIONAL ADMISSIONS EXAMS OR
B.
CORRESPONDENCE
E.
TUITION ASSISTANCE TOP-UP
H.
(Active Duty Only)
NATIONAL EXAMS FOR CREDIT
APPRENTICESHIP OR ON-THE-JOB
C.
F.
FLIGHT TRAINING
TRAINING
4A. WHAT EDUCATION, PROFESSIONAL OR VOCATIONAL GOAL ARE
4B. WHAT IS THE NAME OF THE PROGRAM YOU ARE REQUESTING?
YOU WORKING TOWARD?
4C. IF CHANGING SCHOOLS, GIVE NAME AND COMPLETE ADDRESS OF
4D. NAME AND COMPLETE ADDRESS OF OLD OR CURRENT SCHOOL OR
NEW SCHOOL OR TRAINING ESTABLISHMENT YOU ARE PLANNING
TRAINING ESTABLISHMENT
(If applicable)
TO ATTEND
4E. TELL US WHEN AND WHY YOU STOPPED TRAINING AT YOUR PRIOR SCHOOL OR ESTABLISHMENT. CONTINUE IN REMARKS, ITEM 10, OR ON A SEPARATE
SHEET IF NECESSARY.
PART III - DIRECT DEPOSIT INFORMATION
(Attach a voided personal check or provide the information in items A through D below. Direct Deposit is not available for Chapter 32 recipients.
5. DIRECT DEPOSIT
See instructions for additional Direct Deposit information.)
A. TYPE OF ACCOUNT
CHECKING
SAVINGS
B. NAME OF FINANCIAL INSTITUTION
C. 9 DIGIT ROUTING OR TRANSIT NUMBER
D. ACCOUNT NUMBER
VA FORM
22-1995
SUPERSEDES VA FORM 22-1995, JUL 2013,
JUN 2014
WHICH WILL NOT BE USED.