Military Educational Benefits Questionnaire

First name

Last name

Student ID

Academic Year

Enrollment status

Credit hours per semester

Fall hours

Spring hours

I will receive the following military benefits for the Academic Year:

Veteran Readiness and Employment (CH 31)

yes

VA Benefits

* please check all that apply

Tuition and mandatory fees

Course fees

Books

Stipend

Other…

Stipend per month $ .00

Post 9/11 GI Bill®

yes

Percentage level %

* the percentage levels range from 40% to 100%

Indicate percentage of maximum amount payable & months of eligibility. For new students: Please submit your Certificate of Eligibility with this form. For current students: please submit latest Award Three Letter with remaining amount of benefits.

Months of benefits months

Days of benefits days

'Survivors & Dependents' Educational Assistance (CH 35)

yes

VA Stipend per month

* please check all that apply

Chapter 30

Chapter 35

Chapter 1606

Chapter 1607

Chapter 30 per month

Chapter 35 per month

Chapter 1606 per month

Chapter 1607 per month

Army Continuing Education Benefits -Tuition Assistance

yes

Please indicate dollar amount

Fall $

Spring $

Signature

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