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22-5490
APPLICATION FOR SURVIVORS' AND DEPENDENTS' EDUCATIONAL ASSISTANCE
(Under Provisions of Chapter 35, Title 38,U.S.C.)
VA FORM
JAN 2009
OMB Approved No. 2900-0098
Respondent Burden: 45 minutes
2. SEX OF APPLICANT
4. NAME OF APPLICANT (First, Middle, Last)
12. DATE OF BIRTH
PART I - APPLICANT INFORMATION
3. APPLICANT'S DATE OF BIRTH
5. APPLICANT'S ADDRESS
1. SOCIAL SECURITY NUMBER OF APPLICANT
9. SOCIAL SECURITY NUMBER
13. DATE OF DEATH OR DATE LISTED AS MISSING IN ACTION OR
P.O.W.
PART II - INFORMATION CONCERNING DISABLED OR DECEASED VETERAN OR INDIVIDUAL ON ACTIVE DUTY
PART III - TYPE AND PROGRAM OF EDUCATION OR TRAINING
11. BRANCH OF SERVICE
EXISTING STOCKS OF VA FORM 22-5490, NOV 2005,
WILL NOT BE USED.
FEMALE
INTERNET VERSION AVAILABLE - You may complete and send your application on-line at: www.gibill.va.gov
8. NAME OF INDIVIDUAL ON WHOSE ACCOUNT BENEFITS ARE CLAIMED (First, Middle, Last)
MALE
10. VA FILE NUMBER
(If known)
IMPORTANT: See Attached Information and Instructions.
-- --
Month Day Year
Number and Street
Apt./Unit Number
City, State, ZIP Code
6A. APPLICANT'S TELEPHONE NUMBERS
(Include Area Code)
6B. APPLICANT'S EMAIL ADDRESS (If applicable)
Primary:
Secondary:
SPOUSE SURVIVING SPOUSE ADOPTED CHILDSTEPCHILDCHILD
7. RELATIONSHIP OF APPLICANT TO QUALIFYING INDIVIDUAL
--
-
Day
-
Month Year
COLLEGE OR OTHER SCHOOL APPRENTICESHIP OR OTHER ON-THE-JOB TRAINING
FARM COOPERATIVE
LICENSING OR CERTIFICATION TEST
NATIONAL ADMISSION EXAMS OR NATIONAL EXAMS FOR CREDIT
CORRESPONDENCE COURSE
(Spouse or surviving spouse only)
15. EDUCATION OR TRAINING WILL BE BY: (Check more than one if necessary)
--
YearDayMonth
14. IS THE INDIVIDUAL ON WHOSE ACCOUNT
BENEFITS ARE BEING CLAIMED ON ACTIVE
DUTY? (PL 109-461)
NO
YES
16. PLEASE PROVIDE FULL NAME AND ADDRESS OF SCHOOL OR TRAINING FACILITY, IF KNOWN
Name
Number and Street
City, State, ZIP Code
17. PLEASE SPECIFY YOUR EDUCATION OR CAREER OBJECTIVE, IF KNOWN (E.G. Bachelor of Arts in Accounting, Welding
Certificate, Police Officer)
VA DATE STAMP
(Do Not Write in This Space)
18. DO YOU KNOW THE DATE YOU WILL BEGIN YOUR SCHOOL OR TRAINING?
Page 1 of 7
--
YearDayMonth
A. DATE ENTERED
ACTIVE DUTY
PART V - APPLICANT'S MILITARY SERVICE INFORMATION
(NOTE: Chapter 35 benefits are not payable while an eligible person is on active duty)
--
SOCIAL SECURITY NUMBER OF APPLICANT
PART IV - SPECIAL INFORMATION CONCERNING APPLICANT
A.
YES
F.
NOTE - Complete Item 24 only if you are the civilian employee of the U.S. Government.
19. IF YOU ARE THE SPOUSE OF A DISABLED VETERAN, IS A DIVORCE OR ANNULMENT PENDING?
22. IF YOU ARE THE SURVIVING SPOUSE OF A DECEASED VETERAN, HAVE YOU
REMARRIED SINCE HIS OR HER DEATH ?
24B. SOURCE OF EDUCATIONAL ASSISTANCE FROM GOVERNMENT
EMPLOYMENT
YES NO
YES
NO
24. DO YOU EXPECT TO RECEIVE FUNDS FROM YOUR AGENCY OR DEPARTMENT FOR
THE SAME COURSE FOR WHICH YOU EXPECT TO RECEIVE VA EDUCATIONAL
ASSISTANCE?
(If you check "Yes," show the source of these funds in Item 24B)
NO
25. PRIOR TO THIS APPLICATION, HAVE YOU EVER APPLIED FOR, OR RECEIVED, ANY OF THE FOLLOWING VA BENEFITS?
(Check applicable box(es))
23. SURVIVING SPOUSE'S AGE AT TIME OF REMARRIAGE
B.
C.
D.
E.
G.
DISABILITY COMPENSATION OR PENSION
DEPENDENTS' INDEMNITY COMPENSATION (DIC)
VETERANS' EDUCATION ASSISTANCE BASED ON
YOUR OWN SERVICE (
Specify benefit)
VOCATIONAL REHABILITATION BENEFITS
SURVIVORS' AND DEPENDENTS EDUCATIONAL
ASSISTANCE
(Complete Items 26 and 27)
OTHER (Specify)
NONE
20. ARE YOU A HANDICAPPED CHILD, 14 YEARS OR OLDER, SPOUSE, OR SURVIVING
SPOUSE SEEKING SPECIAL RESTORATIVE TRAINING? (See Instructions)
NO
YES
21. ARE YOU A HANDICAPPED CHILD, SPOUSE, OR SURVIVING SPOUSE
SEEKING SPECIALIZED VOCATIONAL TRAINING? (See Instructions)
NO
YES
IMPORTANT: Complete Items 26 and 27 only if you check "E" in Item 25.
26. NAME OF VETERAN ON WHOSE ACCOUNT YOU PREVIOUSLY CLAIMED BENEFITS
27. VETERAN'S SOCIAL SECURITY OR FILE NUMBER
NO
YES
29. DO YOU OR THE INDIVIDUAL ON WHOSE ACCOUNT
YOU ARE CLAIMING BENEFITS HAVE AN
OUTSTANDING WARRENT?
28. PLEASE PROVIDE THE NAME, ADDRESS, AND PHONE NUMBER OF SOMEONE WHO WILL ALWAYS
KNOW WHERE YOU CAN BE REACHED
31. INFORMATION ABOUT YOUR PERIODS OF ACTIVE DUTY
(Please complete Items 31A through 31D for each period of your active duty)
30. HAVE YOU EVER SERVED ON ACTIVE DUTY IN THE ARMED FORCES? (Including an initial period of active duty for training for a period of 3 months or more
OR subsequent periods of active duty for training of 6 months or more)
(If "NO," skip this part and continue to Part VI)
C. BRANCH OF SERVICE OR RESERVE
OR GUARD COMPONENT
D. CHARACTER OF
DISCHARGE
B. DATE SEPARATED
FROM ACTIVE DUTY
YES NO
--
YearDayMonth
--
YearDayMonth
--
YearDayMonth
--
YearDayMonth
32B. DATE
PART V I- PREVIOUS EDUCATION, TRAINING, AND EMPLOYMENT
32A. CHECK THE APPROPRIATE BOX AND ENTER THE DATE IN ITEM 32B
GRADUATED FROM HIGH SCHOOL
EXPECT TO GRADUATE
NEVER ATTENDED HIGH SCHOOL
GED
DISCONTINUED HIGH SCHOOL
A. EDUCATION AND TRAINING
--
YearDayMonth
MAJOR FIELD OR
COURSE OF STUDY
DEGREE, DIPLOMA,
OR CERTIFICATE
RECEIVED
NUMBER OF
SEMESTER, QUARTER,
OR CLOCK HOURS
COMPLETED
TOFROM
DATES OF TRAINING
NAME AND LOCATION
OF SCHOOL
(City and State)
TYPE OF
SCHOOL
33. EDUCATION
(Include all apprenticeships and on-the-job training)
COLLEGE
HIGH SCHOOL
VA FORM 22-5490, JAN 2009 Page 2 of 7
--
SOCIAL SECURITY NUMBER OF APPLICANT
VOCATIONAL
OR TRADE
33. EDUCATION (Include all apprenticeships and on-the-job training) (Continued)
MAJOR FIELD OR
COURSE OF STUDY
DEGREE, DIPLOMA,
OR CERTIFICATE
RECEIVED
NUMBER OF
SEMESTER, QUARTER,
OR CLOCK HOURS
COMPLETED
TOFROM
DATES OF TRAINING
NAME AND LOCATION
OF SCHOOL
(City and State)
TYPE OF
SCHOOL
OTHER
B. EMPLOYMENT
NUMBER OF MONTHS EMPLOYED
EMPLOYMENT LICENSE OR RATING
PRINCIPAL OCCUPATION
34. CURRENT AND PAST EMPLOYMENT
PART VII - ELECTION (CHILD ONLY)
I CERTIFY THAT I understand the effects of an election to receive DEA
benefits and that I elect to receive such benefits beginning on the
following date:
IMPORTANT: You may not receive payments of Dependency and Indemnity Compensation (DIC) or Pension and you may not be claimed as a
dependent in a compensation claim while receiving Survivors' and Dependents' educational assistance (DEA). CAREFULLY READ THE
INSTRUCTIONS BEFORE COMPLETING THIS ELECTION BLOCK. YOU ARE STRONGLY ENCOURAGED TO DISCUSS YOUR
ELECTION WITH A VA COUNSELOR.
35. DATE OF ELECTION
36. REMARKS
(Use this space to provide information that does not fit elsewhere on this form or that will help VA process your claim. Refer to the item numbers on this
form to help us match your answers to the correct questions. If more space is needed, please attach separate sheets of paper. Be sure to include your name and Social
Security Number on each additional paper you include)
--
YearDayMonth
Page 3 of 7VA FORM 22-5490, JAN 2009
36. REMARKS (Continued)
--
SOCIAL SECURITY NUMBER OF APPLICANT
APPLICATION SUBMISSION REMINDERS AND INFORMATION
I CERTIFY THAT all statements in my application are true and correct to the best of my knowledge and belief.
PART IX - SIGNATURE OF PARENT, GUARDIAN, OR CUSTODIAN
(This section must be completed by the parent, guardian, or custodian if the applicant is a minor)
CUSTODIAN
42B. DATE SIGNED
42A. SIGNATURE OF: (Check one) (Do Not Print)
PENALTY: Willfully false statements as to a material fact in a claim for education benefits is a punishable offense and may result
in the forfeiture of these or other benefits and in criminal penalties.
39. NAME OF PARENT, GUARDIAN, OR CUSTODIAN (First, Middle Initial, Last ) (Type or print)
38B. DATE SIGNED
38A. SIGNATURE OF APPLICANT
(Do NOT Print)
SIGN HERE
IN INK
SIGN HERE
IN INK
PART VIII - CERTIFICATION AND SIGNATURE OF APPLICANT
PARENT
GUARDIAN
Did you remember to:
Write you Social Security Number on Each Page?
Write your complete mailing address?
Attach all supporting documents (e.g. copy of birth certificate, marriage license, etc.)?
IF SO, PLEASE SIGN AND DATE THE APPLICATION IN ITEMS 42A AND 42B.
THE MOST CURRENT INFORMATION ON VA EDUCATION BENEFITS IS AVAILABLE ONLINE AT WWW.GIBILL.VA.GOV.
37. IF YOU WOULD LIKE TO RECEIVE A PRINTED PAMPHLET, CHECK THIS BOX
40. MAILING ADDRESS OF PARENT, GUARDIAN OR CUSTODIAN
City, State, ZIP Code
Apt./Unit Number
Number and Street
41. TELEPHONE NUMBERS OF PARENT, GUARDIAN, OR CUSTODIAN
(Include Area Code)
Secondary:
Primary:
41B. EMAIL ADDRESS OF PARENT, GUARDIAN, OR CUSTODIAN (If Applicable)
Page 4 of 7VA FORM 22-5490, JAN 2009
This form is available on the Internet. We suggest that you file your application by going to www.gibill.va.gov and submitting your application
electronically. Select"ElectronicApplicationForm."
If you submit your application electronically, VA will automatically transfer your application to the Regional Processing Office that handles your
claim. See HOW TO FILE YOUR CLAIM for additional information on sending any supporting documentation and where to mail your completed
paper application.
(Please detach at perforation and retain this information for future reference)
INFORMATION AND INSTRUCTIONS FOR COMPLETING THE APPLICATION
FOR SURVIVORS' AND DEPENDENTS' EDUCATIONAL ASSISTANCE
SPECIFIC INSTRUCTIONS
NOTE: The number on the instructions match the item numbers
on this application. Items not mentioned are self-explanatory.
DO NOT USE THIS FORM TO APPLY FOR VETERANS'
EDUCATION ASSISTANCE (chapters 30, 32, 33,1606, or 1607) or
VOCATIONAL REHABILITATION BENEFITS (chapter 31).
These benefits require different application forms. Use VA Form
22-1990 to apply for Veterans' Education Assistance. This form is
available at www.gibill.va.gov. Use VA Form 28-1900 to apply for
Vocational Rehabilitation benefits See
http://va benefits.vba.va.gov/vonapp/main.asp for the Veterans
On-Line Application for this form. These forms are also available at
your nearest VA regional office and may be available where you
received this application.
ITEM 7. To qualify for Survivors' and Dependents' Educational
Assistance you must be either:
(1) the spouse or child of a veteran who is permanently and totally
disabled as the result of a service-connected disability;
(2) the spouse or child of an individual on active duty who has been
listed for a total of more than 90 days as missing in action, captured
in line of duty by a hostile force, forcibly detained or interned in line
of duty by a hostile force, or forcibly detained or interned in line of
duty by a foreign government or power, or;
(3) the surviving spouse or child of a veteran who died of a service-
connected disability or who died 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 Survivors' and Dependents' Educational Assistance will
be terminated in the event that VA determines that the veteran 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.
NOTE: "Child" includes adopted children and stepchildren who are
members of the veteran's or individual's household. Married children
are eligible for this benefit.
The period of eligibility for a child is generally between the ages of
18 and 26 years. In certain instances, it is possible to begin training
before age 18 and to continue after age 26.
ITEM 10. VA may have assigned the veteran or individual an
eight-digit file number. If you know this number, write it in the space
provided.
ITEM 15. Self-explanatory, except for the following items:
Check the "Licensing or certification test" block if you want
reimbursement for a licensing or certification test. A licensing test is
a test offered by a state, local, or federal agency which is required by
law to practice an occupation. A certification test is a test designed to
provide an affirmation of an individual's qualification in a specific
occupation.
The best way to claim the benefit is for the individual to send VA a
copy of his or her test results with a note or a VA Form 21-4138,
VA FORM
JAN 2009
22-5490
EXISTING STOCKS OF VA FORM 22-5490, NOV 2005,
WILL NOT BE USED.
Statement in Support of Claim, stating that they are requesting
reimbursement. The claimant should include:
(1) The name of the test taken
(2) The name and address of the organization issuing the license or
certificate (not necessarily the organization that administered the test)
(3) The date the test was taken
(4) The cost of the test
(5) The following (signed) statement: "I authorize release of my test
information to VA."
Check the "National admission exams or national exams for credit"
block if you want VA to reimburse you for the fee you paid for taking
one or more national tests. National tests for admission to institutions
of higher learning include the following: the Scholastic Aptitude
Test, Law School Admission Tests, Graduate Record Exam, or the
Graduate Management Admission Test. National tests providing an
opportunity for course credit at institutions of higher learning include
the following: The Advanced Placement Exam and the College-level
Examination Program.
NOTE ON CORRESPONDENCE TRAINING: Only spouses
and surviving spouses may receive benefits for correspondence
training. If you plan to enroll in a correspondence course or a
combination correspondence-residence course, be sure the field
of study is suitable to your abilities and interest before you sign
a contract with the school. Information on correspondence courses
is available at the nearest U.S. Veterans Assistance Center or VA
Regional Office. The correspondence school may require you to
pay for all or the majority of the course even though you complete
only a portion of it. Unlike other VA training programs, payments
for correspondence courses are made quarterly, after VA receives
your certification showing the number of lessons you completed
during the previous quarter. You must affirm a contract for
enrollment in a correspondence course after at least 10 days
following the date you sign the contract. If you decide not to
enroll in a correspondence course after signing a contract but
before signing the affirmation, you are entitled to receive a full
refund from the school of any payment made for the course.
NOTE: You will not be eligible to receive benefits for any period for
which you or the veteran or individual on whose account you are
claiming benefits has an outstanding felony warrant. Any benefits
paid to you for such a period will be an overpayment subject to
collection.
ITEM 22 and 23. A spouse may use educational benefits during the
10-year period after eligibility is found. A surviving spouse may use
these benefits during the 10-year period following the veteran's death
or 10 years after VA determines the veteran's death was caused by a
service-connected disability. The eligibility period
ITEMS 20 and 21. Any eligible person may receive Special
Restorative Training or Specialized Vocational Training, if a VA
counselor determines that a specialized program is needed to
overcome the effects of a physical or mental handicap. To be eligible,
the disability must prevent you from pursuing an educational
program. Examples of Special Restorative Training include speech
and voice correction, language retraining, lip reading, auditory
training, Braille reading and writing, or other similar training.
Specialized Vocational Training consists of specialized courses
leading to a vocational objective. This objective must be suitable
for you and required because of a physical or mental handicap.
Page 5 of 7
RESPONDENT BURDEN: We need this information to determine
your eligibility for education benefits (38 U.S.C. 3513). Title 38
U.S.C. allows us to ask for this information. We estimate that you
will need an average of 45 minutes to review the instructions, find the
information, and complete this form. VA cannot conduct or sponsor a
collection of information unless a valid OMB control number is
displayed. You are not required to respond to a collection of
information if this number is not displayed. Valid OMB control
numbers can be located on the OMB Internet Page at
www.whitehouse.gov/omb/library/OMBINV.VA.EPA.html#VA.
If desired, you can call 1-888-GI-BILL-1 (1-888-442-4551) to get
information on where to send comments or suggestions about this
form.
SPECIFIC INSTRUCTIONS (Continued)
is 20 years for a surviving spouse if the veteran's death was in
service. Eligibility will terminate in the event a spouse is divorced
from the veteran or in the event a surviving spouse is remarried,
unless the remarriage is both after the surviving spouse's 57th
birthday and after January 1, 2004.
NOTE: A surviving spouse who terminates a remarriage may
re-establish eligibility, but will not qualify for an extension of the
ten-year or twenty-year eligibility period.
ITEM 25. If you received education benefits under a law VA
administers, such as the Montgomery GI Bill Educational Assistance
Program, the Montgomery GI Bill Selected Reserve Educational
Assistance Program, the Reserve Educational Assistance Program,or
Post 9/11 GI Bill, specify which benefit in this block.
ITEM 25C. Check the "Vocational Rehabilitation Benefits" block if
you applied for VA education benefits as a disabled veteran.
ITEM 25E. Check the "Survivors' and Dependents' Educational
Assistance" block if you have previously applied for benefits as the
dependent of a veteran other than the veteran or individual on whose
account you are currently claiming benefits.
ITEM 25F. Check the "None" block if you have never previously
applied for VA education benefits.
ITEM 13G. Check the "Other" block if you previously applied for
VA benefits other than any of those specified in Items 25A through
25F.
ITEMS 26 and 27. If you previously applied for VA benefits as the
dependent child or spouse of an individual who is permanently and
totally disabled due to service-connected disabilities or who died on
active duty, provide the name of the individual (your parent or
spouse) and the Social Security Number or the VA file number for
this person in the space provided.
ITEM 30. Benefits under this program are not payable while an
eligible person is serving on active duty in the Armed Forces.
ITEM 32. A child who is under 18 and has not completed high
school must have his or her program of education or training
approved by a VA counselor before educational assistance benefits
can be authorized. An eligible person who has not received a high
school diploma or its equivalent can pursue approved secondary-
level programs. An eligible person can also pursue refresher,
remedial, or deficiency courses needed for admission into an
education program.
ITEM 34. If you have ever held a license to practice a profession or
journeyman rating to work at a trade, state the name of the license or
journeyman rating and the state in which the license was held in the
space marked "License or Rating." We only use this information if
you apply for benefits for a similar program. Examples of a license
include the following: electrician, CPA, teacher, lawyer, and
bricklayer. Use Item 36, "Remarks," if you need more space.
VA VOCATIONAL AND EDUCATIONAL COUNSELING
HELP AVAILABLE. If you need help planning your individual
educational and career goals, VA offers a wide range of counseling
services to help you. Services include educational and vocational
guidance and testing to help you to develop a greater understanding
of your skills, talents, and interests. For further information on VA
counseling, call VA Toll Free at:
1-800-827-1000
or TDD 1-800-829-4833
ITEM 35. Your election to receive Survivors' and Dependents'
Educational Assistance is final and cannot be changed. This means
that payments of compensation, pension, or Dependents' Indemnity
Compensation (DIC) based on school attendance after your 18th
birthday are prohibited once you cash your first benefit check under
Page 6 of 7VA FORM 22-5490, JAN 2009
this chapter. If you are planning to pursue a program of education
for longer than 45 months, you may find it to your advantage to
defer benefits and continue compensation, pension, or DIC payment
for the present. If it appears that a deferral of benefits might be to
your advantage, we strongly recommend that you discuss with a VA
counselor the various options open to you. However, if it does not
appear that a referral would be to your advantage, indicate the date
from which you wish to receive Survivors' and Dependents'
Educational Assistance.
ITEM 37. VA publishes Pamphlet 22-73-3, Summary of
Educational Benefits Under the Survivors' and Dependents'
Educational Assistance Program, Chapter 35 of Title 38, U.S.C., an
information pamphlet for this benefit. You should have received
this pamphlet with your application. If you check "YES," VA will
send you one. You may also request a pamphlet from the person
who furnished your this application.
GENERAL INSTRUCTIONS
ADVANCE PAYMENT - Once you have enrolled in an approved
course, you may receive an advance payment for the first
month (or part of a month) and second month of enrollment
if ALL the following conditions are met:
.
.
.
.
You are enrolled on at least a half-time basis, and
Your school has agreed to receive and process
advance payment checks for delivery to it students, and
You request advance payment by signing a request block
on the enrollment certification your school sends to us, and
VA receives your enrollment certification at least 30 days
before classes start
NOTE: If we do not pay an advance payment, we will pay you
after each month you attend school. In some cases, VA will require
you to verify your enrollment each month before you receive
payment.
IMPORTANT: Additional requirements set by law may prevent us
from making an advance payment.
HELP: If you need help in completing this application, call VA
TOLL FREE at 1-888-GI-BILL-1 (1-888-442-4551). If you are
hearing impaired, call us toll-free at 1-800-829-4833. Our education
Internet site (www.gibill.va.gov) is available to help you.
PRIVACY ACT INFORMATION: VA will not disclose
information collected on this form to any source other than what has
been authorized under the Privacy Act of 1974 or Title 38, Code of
Federal Regulations 1.576 for routine uses (i.e., awards of benefits)
as identified in the VA system of records, 58VA21/22,
Compensation, Pension, Education and Rehabilitation Records -
VA, and published in the Federal Register. Your obligation to
respond is required to obtain education benefits. Giving us your SSN
account information is voluntary. Refusal to provide your SSN by
itself will not result in the denial of benefits. VA will not deny an
individual benefits for refusing to provide his or her SSN unless the
disclosure of the SSN is required by a Federal Statute of law in
effect prior to January 1, 1975, and still in effect. The requested
information is considered relevant and necessary to determine the
maximum benefits allowable under the law. While you do not have
to respond, VA cannot process your claim for benefits unless the
information is furnished as required by existing law (38 U.S.C.
3513). The responses you submit are considered confidential (38 U.
S.C. 5701). Information submitted is subject to verification through
computer matching programs with other agencies.
(B) not selected a school or training establishment,
(A) selected a school or training establishment,
Western Region:
VA Regional Office
P. O. Box 8888
Muskogee, OK 74402-8888
CT
SERVES THE FOLLOWING STATES
Southern Region:
VA Regional Office
P. O. Box 100022
Decatur, GA 30031-7022
SERVES THE FOLLOWING STATES
DE DC ME
MD MA NH NJ
NY OH PA RI
VT VA WV
Foreign
Schools
Eastern Region:
VA Regional Office
P. O. Box 4616
Buffalo, NY 14240-4616
Central Region:
VA Regional Office
P. O. Box 66830
St. Louis, MO 63166-6830
SERVES THE FOLLOWING STATES
CO ILIA
IN
KS MIKY MN
MO NEMT ND
SD WITN
AK AZ ALAR CA
FL
NC
MS
PR
GA
SC
TX
HI LAID NM
NV
WAUT
Philippines
HOW TO FILE A COMPLETED ELECTRONIC APPLICATION
Step 2: Notify the VA certifying official at your school or training establishment that you have applied for VA education benefits.
Ask him or her to submit your attendance information using VA Form 22-1999, Enrollment Certification, or its electronic version.
HOW TO FILE A COMPLETED PAPER APPLICATION
SERVES THE FOLLOWING STATES
OK OR
If you have:
If you completed your application electronically, VA furnished you with the following: (1) a unique confirmation number for your
individual claim and (2) the address of the VA office (Education Regional Processing Office) that will process your claim. You need to
write this information down and keep it in a safe location.
If you have:
Step 1: Mail the completed form to the VA Regional Processing Office in the region of your home address. Check below for the post
office box address for these offices.
Step 2: Wait for VA to process your application and notify you of our decision concerning your eligibility for education assistance.
Step 1: Mail the completed form to the VA Regional Processing Office in the region of that school's physical address. Check below
for the post office box address for these offices.
Step 3: Wait for VA to process your application and notify you of our decision concerning your eligibility for education assistance.
.
.
.
.
.
WY
(B) not selected a school or training establishment, wait for VA to process your application and notify you of our decision
concerning your eligibility for educational assistance.
(A) selected a school or training establishment, follow the same action as shown in (A), step 2, above.
US Virgin
Islands
Page 7 of 7VA FORM 22-5490, JAN 2009
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-- -- APPLICATION FOR SURVIVORS' AND DEPENDENTS' EDUCATIONAL (Triton College)

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