Va Form 22-1990 - Application For Va Education Benefits Page 5

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SOCIAL SECURITY NUMBER OF APPLICANT

10B. PROVIDE THE FULL NAME AND ADDRESS OF THE SCHOOL, IF KNOWN (Skip this item if you are only applying for National Test Reimbursement, Licensing and

Certification Test Reimbursement, or Tuition Assistance Top-Up)

10C. PLEASE SPECIFY YOUR EDUCATIONAL OR CAREER OBJECTIVE, IF KNOWN (e.g. Bachelor of Arts in Accounting, welding certificate, police officer, etc.)

PART IV - SERVICE INFORMATION

NOTE: It will help VA process your claim if you send a copy of the following:

• DD Form 214 (Member 4) for all periods of active duty service (excluding active duty for training)

• DD Form 2384, Notice of Basic Eligibility (NOBE) if applying for Chapter 1606

• Copies of orders if activated from the guard/reserves

11. ARE YOU NOW ON ACTIVE DUTY? (Do not check "Yes" if you are currently on drilling status in the the Selected Reserve, or if you are on active duty for training)

YES

12. ARE YOU NOW ON TERMINAL LEAVE JUST BEFORE DISCHARGE?

(Please provide a copy of your DD Form 214 (Member 4) when issued)

YES

13. PLEASE COMPLETE THE FOLLOWING FOR EACH PERIOD OF MILITARY SERVICE

C. SERVICE COMPONENT (USN,

D. SERVICE STATUS (Active duty,

E. WERE YOU INVOLUNTARILY CALLED TO

A. DATE ENTERED

B. DATE SEPARATED

USAF, USAR, ARNG, ETC.)

drilling reservist, IRR, etc.)