California State University Chico
Office of Veterans’ Affairs
Intake Sheet
Name Student ID #
SSN - -
VA File Number, if different than SSN
1) Have you used benefits before? (Check one) YES NO If yes, date last used:
YES NO
2) If no to #1, have you applied to VA for your benefits? (Check one)
3) If yes to #2, did you apply on-line via VETS.GOV? (Check one)
YES NO
VA Educational Benefits that you are expecting:
Veterans Dependents
Chapter 30 (MGIB) Chapter 31 (Voc Rehab) Chapter 35 (Dependents)
Chapter 1606 (Res & NG) Chapter 33 (Post 9/11 Veteran) Chapter 33 (Post 9/11 Dependent)
Dependents: Please fill out this section to the best of your ability. The information is used to identify
your file. If you are sure that the file number is accurate, this information becomes less critical.
Veteran’s Name: VA File Number
Veteran’s Date of Birth Veteran’s SSN - -
Veteran is: Disabled or Deceased If disabled, what is VA rating? %
If dependent child, are you aware of the Cal-Vet education fee waiver program? YES NO
Transfer Credit: I understand that I must provide copies of all transcripts to the Office of Admissions.
This includes all military transcripts and/or a copy of your DD-214.
*** I have received a copy of the ‘How to Receive Benefits’ handout: Yes No ***
*** I am aware of how to apply for Financial Aid which I may be entitled: Yes No ***
Authorization to share confidential information:
In order to best facilitate the administration of my VA education benefits, I hereby authorize the release of
information concerning my benefits and enrollment status to all staff members of the CSUC Office of
Veterans’ Affairs (OVA). I understand that OVA staff must safeguard and may share my confidential
information with other institutions which I have attended or will attend as required to ensure correct
benefit payments.
Electronic Authorization:
I understand that I must submit this form with my Wildcat Email to the Office of Veterans’ Affairs via
VA@csuchico.edu . All of the information contained on this form is correct to the best of my knowledge.
Submitting this form with my Wildcat Email constitutes my authorized consent.