Military Services Center
Simmons Hall Room 120 (330) 972-7838
Veterans Request Form
Must Be Completed Prior to Each Semester
Semester_________,20____. Total credit hours you want benefits for this term._________
Name (First MI Last ) _______________________________ UA ID#___________________
Date of Birth__________ Contact Number _______________ Secondary Number ______________
New Address? Yes No
Street Address_________________________________ City, State_____________________
Zip Code__________________ P.O Box # __________________
Campus/College (i.e. Main, Summit) _______________
DEGREE (AA, BA, BS, MPH)________ MAJOR (i.e. Psychology)_______________________
If applicable, specify concentration.___________________
Is this a change of major? Yes No If yes, you must fill out a VA form 1995 (COP)
As of date: ___________________
Student Status: Undergraduate Graduate
Semester last attended UA__________, _____
Did you receive VA Benefits? Yes No
Are you applying for Financial Aid? Yes No Do you have Scholarships, Pell, OCOG?
Are you under contract with ROTC? Yes No Did you apply for ONGS? Yes No
Chapter of benefits requested: (Check one)
___ 33 Post 9/11 GI Bill (Veteran will forfeit previous benefit)
___ 30 Are you currently on active duty or AGR __________
___ 1606 National Guard/Reserve (If applicable, remember to apply for the ONG scholarship)
___ 1607 National Guard/Reserve (If applicable, remember to apply for the ONG scholarship)
___ 35 Dependant/Child/Disabled Vet VA Claim Number C__________________________
___ 31 VOC Rehab
If you have attended any other college or university and have not reported prior/transfer credits to The
University of Akron, please indicate below and complete VA form 1995 (COP).
Name of Institution __________________________ Dates Attended_____________________
Name of Institution __________________________ Dates Attended_____________________
Are you repeating any classes during this semester? Yes No
If yes, please explain _______________________________________________________________
By signing below, I certify that all of the courses listed on my schedule will apply toward my degree either
because they are required or will serve as electives. In addition, I certify that all information on this form
is true and accurate to the best of my knowledge and that I have read the Veteran’s Responsibilities
Form and I will comply with all regulations specified. I authorize The University of Akron to release any
information pertaining to my school record to the Veterans Administration as needed
Student Signature: ___________________________Date:_______________________
MSC Counselor Initials & Date: _______________ (for office use only)