Va Form 22-5495 - 2010 Dependents' Request For Change Of Program Or Place Of Training Page 3
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4INFORMATION AND INSTRUCTIONS FOR COMPLETING THE
DEPENDENTS' REQUEST FOR CHANGE OF PROGRAM OR PLACE OF TRAINING
(VA FORM 22-5495)
Use this form to request a change of program or place of training under the following benefit programs:
• Survivors' and Dependents' Educational Assistance Program (chapter 35 of title 38, U.S. Code)
• Post-9/11 GI Bill Marine Gunnery Sergeant John David Fry Scholarship (chapter 33 of title 38, U.S. Code)
Do not use this form to apply for a change of program or place of training for Veterans' education assistance based on your own service
(chapters 30, 32, 33, 1606, or 1607). To apply for a change of program or place of training for Veterans' education assistance benefits based
on your own service, use VA Form 22-1995.
INTERNET VERSION AVAILABLE- You may complete and submit this application on-line at Click on "GI Bill:
Apply for Benefits."
VA VOCATIONAL AND EDUCATIONAL COUNSELING HELP AVAILABLE- VA offers a wide range of services to assist you
in planning your education and/or career goals. Services include educational and vocational guidance and testing to develop a greater
understanding of your skills, talents, and interests. For more information on VA counseling, call VA toll-free at 1-888-GI-BILL-1
(1-888-442-4551) or TDD at 1-800-829-4833.
NOTE: These numbers on the instructions match the item numbers on the application. Items not mentioned are self-explanatory.
ITEM 3. Your VA FILE NUMBER is the number that appears on your VA benefit checks and all mail that we've sent to you. Generally,
your VA FILE NUMBER is the social security number of the individual on whose account you are receiving benefits. Your SUFFIX
(letter or 2-digit number) indicates your relationship to the qualifying individual.
ITEM 17. To qualify for Survivors' and Dependents' Educational Assistance (DEA), you must be either-
(1) The spouse or child of a veteran who is permanently or totally disabled as a result of a
service-connected disability.
(2) The spouse or child of an individual on active duty who has been listed as missing in action,
captured in line of duty by hostile force, forcibly detained or interned in line of duty by hostile
force, or forcibly detained or interned in line of duty by a foreign government or power for more
than 90 days.
(3) The surviving spouse or child of a veteran who died of a service-connected disability or who
dies while a service-connected disability was rated permanent and total in nature.
(4) The spouse or child of an individual on active duty for which the evidence shows that the
individual is hospitalized for receiving outpatient medical care services or treatment; has a
total disability permanent in nature incurred or aggravated in the line of duty in the active
military, naval, or air service; and the serviceperson is likely to be discharged or released
from such service for such disability.
Eligibility for DEA will be terminated in the event that VA determines that the individual on whose account benefits are claimed is no longer
totally disabled or VA is notified that the individual is no longer listed as captured, missing in action, or forcibly detained.
To qualify for the Fry Scholarship, you must be the child of an individual who after September 10, 2001, died in the line of duty while
serving on active duty as a member of the Armed Forces.
ITEM 21. Select the benefit under which you are applying for a change in program or place of training. Types of education or training
programs are self-explanatory, except for the following-
"Licensing or Certification Test." A licensing test is a test offered by a state, local, or federal agency that is required by law to practice an
occupation. A certification test is a test designed to provide affirmation of an individual's qualifications in a specific occupation. "National
Admissions Exams or National Exams for Credit." Individuals eligible to receive benefits under the Survivors' and Dependents' Educational
Assistance program may be reimbursed for the cost of approved test for admission to or credit at institutions of higher learning.
"Correspondence." Only spouses and surviving spouses eligible for the Survivors' and Dependents' Educational Assistance program may
receive benefits for correspondence training. Payments for correspondence courses are made quarterly after VA receives a certification
showing the number of lessons completed. For more information on correspondence courses, please visit our website at
Page 3
VA FORM 22-5495, OCT 2010
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