This f
orm must be returned to the School Certifying Official in the Registrar’s Office 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 rece
iving veterans benefits Yes No
If No, please hand in this form to cease correspondence from the School Certifying Official.
I plan on filli
ng out the Free Application for Federal Student Aid (FAFSA) in addition to my veteran’s benefits
Yes No
**I und
erstand that my financial aid package may be adjusted if my tuition is covered 100% by any of the
veterans benefit programs listed below. Institutional grants (ex: Edgewood Grant, Academic Scholarships)
are not available to students in this situation. ___________________ (Initial here).
I am rece
iving 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 y
ou currently serving in the military? Yes No
If Yes, are you currently on Active Duty? Yes No
Have yo
u 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.
Chapter 35 – Survivors and Dependents
GoArmyEd Tuition Assistance
National Guard Tuition Grant (WI state benefit)
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 1607 – Montgomery GI Bill, REAP
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)? Yes No
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.
Addit
ionally, 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 benefit
s.
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.
_______
____________________________________________________________ __________________________
(Student Signature) (Date)
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