Va Form 22-1990 - Application For Va Education Benefits Page 4
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7OMB Control No. 2900-0154
Respondent Burden: 15 minutes
Expiration Date: 10/31/2017
APPLICATION FOR VA EDUCATION BENEFITS
(See attached Information and Instructions)
INTERNET VERSION AVAILABLE - You may complete and send your application over the Internet at:
PART I - APPLICANT INFORMATION
1. SOCIAL SECURITY NUMBER OF APPLICANT
2. SEX OF APPLICANT
3. APPLICANT'S DATE OF BIRTH
Month
Day
Year
MALE
FEMALE
4. NAME (First, Middle Initial, Last)
5. APPLICANT'S ADDRESS
Number and Street
Apt./Unit Number
City, State, ZIP Code
6A. APPLICANT'S TELEPHONE NUMBERS (Include Area Code)
Primary:
Secondary:
6B. APPLICANT'S E-MAIL ADDRESS (If applicable)
7. DIRECT DEPOSIT (Attach a voided personal check or provide the following information. Direct Deposit is not available for Chapter 32 recipients. See instructions for additional Direct
Deposit information.)
Routing or Transit Number
Account Type
Account Number
Checking
Savings
8. PLEASE PROVIDE THE NAME, ADDRESS, AND PHONE NUMBER OF SOMEONE WHO WILL ALWAYS KNOW WHERE YOU CAN BE REACHED
A. NAME
B. ADDRESS
C. PHONE NUMBER
PART II - EDUCATION BENEFIT BEING APPLIED FOR
(See instructions for benefit eligibility criteria)
9A. Chapter 33 - Post-9/11 GI Bill (Complete 9F if you are eligible for chapter 30, chapter 1606, or chapter 1607)
9B. Chapter 30 - Montgomery GI Bill Educational Assistance Program (MGIB)
9C. Chapter 1606 - Montgomery GI Bill - Selected Reserve Educational Assistance Program (MGIB-SR)
9D. Chapter 1607 - Reserve Educational Assistance Program (REAP)
9E. Chapter 32 or Section 903 - Post-Vietnam Era Veterans' Educational Assistance Program (VEAP)
9F. By electing Chapter 33, I acknowledge that I understand the following:
•
I may not receive more than a total of 48 months of benefits under two or more programs.
•
If electing chapter 33 in lieu of chapter 30, my months of entitlement under chapter 33 will be limited to the number of
months of entitlement remaining under chapter 30 on the effective date of my election.
•
My election is irrevocable and may not be changed.
I elect to receive chapter 33 education benefits in lieu of the education benefit checked below, effective
I understand that my election is irrevocable and may not be changed. (Check only one)
(date)
Chapter 30 - Montgomery GI Bill Educational Assistance Program (MGIB)
Chapter 1606 - Montgomery GI Bill - Selected Reserve Educational Assistance Program (MGIB-SR)
Chapter 1607 - Reserve Educational Assistance Program (REAP)
VA DATE STAMP
PART III - TYPE AND PROGRAM OF EDUCATION OR TRAINING
(Do Not Write In This Space)
10A. TYPE OF EDUCATION OR TRAINING (See instructions for additional information)
COLLEGE OR OTHER SCHOOL (Including on-line courses)
APPRENTICESHIP OR ON-THE-JOB
VOCATIONAL FLIGHT TRAINING
CORRESPONDENCE
NATIONAL TEST REIMBURSEMENT (SAT, CLEP, ETC.)
TUITION ASSISTANCE TOP-UP
(Chapter 30 & 33 only)
LICENSING OR CERTIFICATION TEST REIMBURSEMENT
(MCSE, CCNA, EMT, NCLEX, ETC.)
VA FORM
22-1990
SUPERSEDES VA FORM 22-1990, JUN 2014,
PAGE 1 OF 4
NOV 2014
WHICH WILL NOT BE USED.
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