Va Form 22-1990 - Application For Va Education Benefits Page 6
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7SOCIAL SECURITY NUMBER OF APPLICANT
14D. EMPLOYMENT (Only complete if you held a license or journeyman rating to practice a profession)
NUMBERS OF MONTHS
EMPLOYMENT
PRINCIPAL OCCUPATION
LICENSE OR RATING
WORKED
BEFORE MILITARY SERVICE
AFTER MILITARY SERVICE
PART VI - ENTITLEMENT TO AND USAGE OF ADDITIONAL TYPES OF ASSISTANCE
15. DID YOU MAKE ADDITIONAL CONTRIBUTIONS (UP TO $600.00) TO INCREASE THE AMOUNT OF YOUR MONTHLY
YES
NO
BENEFITS? IF "YES," IT WILL HELP VA PROCESS YOUR CLAIM IF YOU SUBMIT ANY EVIDENCE YOU HAVE TO
SUPPORT YOUR CLAIM (e.g., cash collection voucher, leave and earnings statement(s), receipt voucher, etc.)
ACTIVE DUTY KICKER
16. DO YOU QUALIFY FOR A KICKER (sometimes called a "College Fund") BASED ON YOUR MILITARY SERVICE?
YES
NO
(Kickers are additional amounts contributed by DOD to an education fund). If you qualify for a kicker, it will help VA
RESERVE KICKER
process your claim if you submit a copy of the kicker contract. Reserve kicker contracts must include the amount and
effective date.
YES
NO
Graduation Year
17. IF YOU GRADUATED FROM A MILITARY SERVICE ACADEMY, SPECIFY THE YEAR YOU GRADUATED AND
RECEIVED YOUR COMMISSION.
18. WERE YOU COMMISSIONED AS THE RESULT OF A SENIOR ROTC (Reserve Officers Training Corps) SCHOLARSHIP?
YES
NO
If you received your commission through a non-scholarship program, check "No." If "Yes," provide the date of your
commission and the amount of your scholarship for each school year you were in the Senior ROTC program. Don't report
your monthly subsistence allowance (stipend).
Scholarship Amounts:
Date of Commission
Year:
Amount:
Year:
Amount:
Year:
Amount:
Year:
Amount:
Year:
Amount:
19. ARE YOU CURRENTLY PARTICIPATING IN A SENIOR ROTC SCHOLARSHIP PROGRAM THAT PAYS FOR YOUR
YES
NO
TUITION, FEES, BOOKS AND SUPPLIES UNDER SECTION 2107 OF TITLE 10, U.S. CODE?
20. IF YOU HAD A PERIOD OF ACTIVE DUTY THAT THE DEPARTMENT OF DEFENSE COUNTS FOR PURPOSES OF
YES
NO
REPAYING AN EDUCATION LOAN, CHECK "YES". SHOW THE PERIOD OF ACTIVE DUTY THAT THE MILITARY
CONSIDERS AS BEING USED FOR THE PURPOSES OF REPAYING THIS EDUCATION LOAN IN PART IX "REMARKS".
21. FOR ACTIVE DUTY CLAIMANTS ONLY: ARE YOU RECEIVING, OR DO YOU ANTICIPATE RECEIVING, ANY MONEY
YES
NO
(INCLUDING BUT NOT LIMITED TO FEDERAL TUITION ASSISTANCE) FROM THE ARMED FORCES OR PUBLIC
HEALTH SERVICE FOR THE COURSE FOR WHICH YOU HAVE APPLIED TO THE VA FOR EDUCATION BENEFITS? IF
YOU RECEIVE SUCH BENEFITS DURING ANY PART OF YOUR TRAINING, CHECK "YES." NOTE: IF YOU ARE ONLY
APPLYING FOR TUITION ASSISTANCE TOP-UP, CHECK NO IN THIS ITEM.
22. FOR CIVILIAN EMPLOYEES OF THE U.S. GOVERNMENT ONLY: ARE YOU RECEIVING, OR DO YOU ANTICIPATE
YES
NO
RECEIVING, ANY MONEY (INCLUDING, BUT NOT LIMITED TO, THE GOVERNMENT EMPLOYEES TRAINING ACT)
FROM YOUR AGENCY FOR THE SAME PERIOD FOR WHICH YOU HAVE APPLIED TO THE VA FOR EDUCATION
BENEFITS? IF YOU WILL RECEIVE SUCH BENEFITS DURING ANY PART OF YOUR TRAINING, CHECK "YES."
PAGE 3 OF 4
VA FORM 22-1990, NOV 2014
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