If No, pleas
e hand in this form to cease correspondence from the School Certifying Official.
I plan on filling out the Free
Application for Federal Student Aid (FAFSA) in addition to my veteran’s benefits
Yes No
I am receiving veterans benefits from a spouse or parent? Yes No
If Yes, please provide their SSN or VA file# _________________
If you are receiving Transfer of Entitlement (TOE) funds, is your spouse/parent on Active Duty? Yes No
Are you currently serving in the military? Yes No
If Yes, are you currently on Active Duty? Yes No
Have you received veterans benefits before at another institution? Yes No
If Yes, you will need to complete and hand in with this form the 22-1995: Change of Program Form or the 22-5495:
Dependents’ Request for Change of Program Form for students using TOE funds.
Please check which benefit program(s) you will be using:
Chapter 30 Montgomery GI Bill, Active Duty Assistance
Chapter 1606 Montgomery GI Bill, Selected Reserve
Chapter 31 Vocational Rehabilitation
Chapter 33 Post 9/11 GI Bill
Are you eligible for the Yellow Ribbon program (i.e.
100% eligible under Chp 33)?
Chapter 35 Survivors and Dependents
VetEd (WI State benefit)
National Guard Tuition Grant (WI state benefit)
Federal Tuition Assistance
I authorize Edgewood College to communicate with the Department of Veterans Affairs (VA) and any branch of the Department
of Defense (DoD) in regards to the processing of military or
veterans benefits. I understand that the VA or the DoD may require
that Edgewood College send copies of my academic record for review without my further authorization. Yes No
Additionally, I
understand that it is my responsibility to notify the Certifying Official of any and all changes related to 1)
my benefits eligibility, 2) changes to my program of study and 3) my current enrollment status at Edgewood College.
Failure to report these changes in a timely manner could result in a delay in the processing of my benefits. Students
will only be certified for courses required for their graduation requirements including program and general education
requirements. Courses that do not meet these criteria will not be certified. Yes No
(Student Signature)
This form must be returned to the School Certifying Official in the Registrar’s Office or the Director of the Office of Military &
Veterans Services in order to ensure the prompt processing of your veterans benefits. Unsigned forms will not be accepted.
Name _____________________________________________ SSN#_____________________ ID#__________________
I plan on starting classes at Edgewood College__________________ (year/term).
Anticipated Graduation date _________________ (year/term).
I am receiving veterans benefits Yes No
Edgewood College
Contact the School Certifying Official or the Director of Military & Veterans Services
(VeteransBenefits@edgewood.edu; 608-663-4266) with any questions.
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