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VDBA (University of Saint Thomas)

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VETERANS & DEPENDENTS BENEFITS AUTHORIZATION FORM
Complete this form for the academic year 2018-2019
Email completed form to: Registrar@stthomas.edu
Debbie Shelito, School Certifying Official -- Phone: 651-962-6725
NAME ST. THOMAS STUDENT ID # ACADEMIC LEVEL
(GRADUATE - UNDERGRADUATE)
**** Chapter 33 students with benefits less than 100%: Be mindful of reaching the VA academic year cap from fall
semester. If cap has been reached, VA will not pay tuition/fees; however, they will pay your housing allowance. You will be using
your time without the benefit of tuition paid. Please take this in consideration when authorizing future semesters. ****
CHECK SEMESTER(S) AUTHORIZING VA BENEFITS
Fall Semester 2018
J-Term 2019
Spring Semester 2019
Summer Semester 2019
VA EDUCATION BENEFIT PROGRAM – SELECT ONE
Chapter 30 – Montgomery GI Bill
Chapter 30 – must verify enrollment monthly to receive payment.
Online – www.gibill.va.gov/wave or by telephone 877-823-2378
Chapter 31 – Vocational Rehabilitation
VA Counselor’s Name
Chapter 33 – Post 9/11 GI Bill
Check if Active Duty
- or -
Check if Spouse of Active Duty Veteran
Chapter 35 –
Dependents Education Assistance
(veteran disabled)
Veterans File Number or Social Security Number
(Required first time new student)
Chapter 35 – Fry Scholarship
(veteran died line of duty)
Veterans File Number or Social Security Number
(Required first time new student)
-or-
Choose one:
Chapter 1606 – Select Reserve
Federal Tuition Assistance
Chapter 1606 – must verify enrollment monthly to receive payment.
Online – www.gibill.va.gov/wave or by telephone 877-823-2378
Apply at least 60 days prior to start of term.
ARE YOU CHANGING PROGRAMS OR PLACE OF TRAINING?
Yes, I am changing program or place of training.
• If yes, Chapters 30, 33 1606 complete VA form 22-1995 located at www.vets.gov.
• If yes, Chapter 35 complete VA form 22-5495 located at www.vets.gov .
CHAPTER 33 RECIPIENTS PROVIDE A CURRENT STATEMENT OF BENEFITS EACH ACADEMIC YEAR
.
Yes, Statement of Benefits attached.
• Then anticipated funds can be applied to your account prior to VA submitting payment.
• Obtain statements at www.vets.gov or award letters can be provided to School Certifying Official
The Yellow Ribbon program is available to:
• Chapter 33 recipients at the 100% eligibility rate
• Veterans that are not on active duty
• Students that have not had a break in attendance
~~~~~~~~~~
• I authorize my enrollment information for the above-specified term(s) be certified with the VA.
• It is my responsibility to notify the School Certifying Official of any changes in my enrollment.
• Any enrollment adjustment I make may result in a change to the benefit amount I receive from the VA.
• I am responsible for any overpayment created by these adjustments and all University bills if funding is withheld.
• I certify that the courses for which I have enrolled meet my degree requirements.
• I understand that the VA will not pay for courses that do not meet my degree requirements and the VA will not pay for
audited courses.
Signature: __________________________________ Date: ____________________________
If unable to obtain an electronic signature thru Adobe, sending this form from your St. Thomas email account will act as your
signature.
Email completed form to: Registrar@stthomas.edu
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VDBA (University of Saint Thomas)

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Completed 26 July 2020

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