1C. APPLICANT'S TELEPHONE NUMBER (Including Area Code) 5. DIRECT DEPOSIT (Complete this item only if you wish to start, change or stop direct deposit.) NOTE: To prevent possible delays in payment, claimants are highly encouraged to use Direct Deposit and set up an Electronic Fund Transfer (EFT.) Direct Deposit is not available for the Post-Vietnam Era Educational Assistance Program (VEAP - Chapter 32) nor for Section 903. A. TYPE OF ACCOUNT 3. HOW WILL YOU TAKE TRAINING? 4C. IF CHANGING SCHOOLS, PROVIDE NAME AND COMPLETE ADDRESS OF NEW SCHOOL OR TRAINING ESTABLISHMENT YOU ARE PLANNING TO ATTEND (If applicable) PART I - IDENTIFICATION AND PERSONAL INFORMATION OMB Control No. 2900-0074 Respondent Burden: 20 Minutes Expiration Date: 05-31-2018 REQUEST FOR CHANGE OF PROGRAM OR PLACE OF TRAINING 1B. MAILING ADDRESS (Complete street address, City, State, and 9-digit ZIP Code) VA DATE STAMP DO NOT WRITE IN THIS SPACE PART III - DIRECT DEPOSIT INFORMATION 4D. PROVIDE NAME AND COMPLETE ADDRESS OF PREVIOUS SCHOOL OR TRAINING ESTABLISHMENT (If only changing schools, list current school.) 4A. WHAT EDUCATIONAL, PROFESSIONAL OR VOCATIONAL GOAL ARE YOU WORKING TOWARD? 4B. WHAT IS THE NAME OF THE PROGRAM YOU ARE REQUESTING? 1A. NAME OF APPLICANT (Last, First, Middle) NATIONAL ADMISSIONS EXAMS OR NATIONAL EXAMS FOR CREDIT H. CHAPTER 33 (Post-9/11 GI BILL) CHAPTER 30 (Montgomery GI Bill - Active Duty) VA FORM OCT 2015 22-1995 SUPERSEDES VA FORM 22-1995, JUN 2015, WHICH WILL NOT BE USED. CHECKING C. 9 DIGIT ROUTING OR TRANSIT NUMBER D. ACCOUNT NUMBER LICENSING & CERTIFICATION TEST TRANSFER OF ENTITLEMENT PROGRAM B. NAME OF FINANCIAL INSTITUTION 1E. APPLICANT'S E-MAIL ADDRESS 4E. TELL US WHEN AND WHY YOU STOPPED TRAINING AT YOUR PRIOR SCHOOL OR ESTABLISHMENT. CONTINUE IN REMARKS, ITEM 10, OR ON A SEPARATE SHEET IF NECESSARY. 1D. VA FILE NUMBER EVENING 1F. SOCIAL SECURITY OF APPLICANT (For transferability cases, enter the veteran's social security number) DAY FLIGHT TRAINING CHAPTER 32 (Veterans Educational Assistance Program including section 903) CHAPTER 1606 (Montgomery GI Bill- Selected Reserve) B. A. F. TUITION ASSISTANCE TOP-UP (Active Duty Only) D. G. F. C. 2. EDUCATION BENEFIT YOU WANT TO RECEIVE (Only Select One) E. CORRESPONDENCE B. SCHOOL ATTENDANCE APPRENTICESHIP OR ON-THE-JOB TRAINING C. A. COOPERATIVE TRAINING D. CHAPTER 1607 (Reserve Educational Assistance Program) E. STOP EFT START OR CHANGE EFT (Please attach a voided personal check or provide the information in items A through D below.)
7. RECENT PERIODS OF SERVICE (PERIODS OF ACTIVE DUTY SINCE YOUR INITIAL PERIOD OF ACTIVE DUTY.) Please complete this section for each period of your active duty since your initial period of active duty if you have not previously reported this information. It will help VA process your claim if you attach a certified copy of "Member 4 Copy" of your DD Form 214 for each period of active service.
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- Fall '08
- G.I. Bill, active duty