Request For Change Of Program Or Place Of Training Please enable JavaScript in your browser to complete this form.Please enable JavaScript in your browser to complete this form.1A. NAME OF APPLICANT (Last, First, Middle) *1B. MAILING ADDRESS (Complete street address, City, State, and 9-digit ZIP Code) 1C. APPLICANT'S TELEPHONE NUMBER (Including Area Code)MOBILE (include area code) 1C. APPLICANT'S TELEPHONE NUMBER (Including Area Code) HOME (include area code) 1D. VA FILE NUMBER1E. APPLICANT'S E-MAIL ADDRESS (if applicable)1F. SOCIAL SECURITY NUMBER OF APPLICANT (For transferability cases, enter the veteran's social security numberPART II - YOUR PROGRAM INFORMATION Selected Value: 0 2. EDUCATION BENEFIT YOU WANT TO RECEIVECHAPTER 33 (Post-9/11 GI BILL)CHAPTER 30 (Montgomery GI Bill - Active Duty)CHAPTER 32 (Veterans Educational Assistance Program including section 903)TRANSFER OF ENTITLEMENT PROGRAMCHAPTER 1606 (Montgomery GI BillSelected Reserve)3. HOW WILL YOU TAKE TRAINING?SCHOOL ATTENDANCEAPPRENTICESHIP OR ON-THE-JOB TRAININGTUITION ASSISTANCE TOP-UP (Active Duty Only)LICENSING & CERTIFICATION TESTCORRESPONDENCECOOPERATIVE TRAININGFLIGHT TRAININGNATIONAL ADMISSIONS EXAMS OR NATIONAL EXAMS FOR CREDIT4A. WHAT EDUCATIONAL, PROFESSIONAL OR VOCATIONAL GOAL ARE YOU WORKING TOWARD?4B. WHAT IS THE NAME OF THE PROGRAM YOU ARE REQUESTING?4C. IF CHANGING SCHOOLS, PROVIDE NAME AND COMPLETE ADDRESS OF NEW SCHOOL OR TRAINING ESTABLISHMENT YOU ARE PLANNING TO ATTEND (If applicable) 4D. PROVIDE NAME AND COMPLETE ADDRESS OF PREVIOUS SCHOOL OR TRAINING ESTABLISHMENT (If only changing schools, list current school)4E. TELL US WHEN AND WHY YOU STOPPED TRAINING AT YOUR PRIOR SCHOOL OR ESTABLISHMENT. CONTINUE IN REMARKS, ITEM 10, OR ON A SEPARATE SHEET IF NECESSARY. (If applicable)PART III - DIRECT DEPOSIT INFORMATION Selected Value: 0 5A. DIRECT DEPOSIT (To enroll in Direct Deposit, attach a voided personal check or deposit slip to match the information provided below. Direct Deposit is not available for Chapter 32 recipients.) NOTE: To prevent possible delays in payment, claimants are highly encouraged to use Direct Deposit and set up an Electronic Fund Transfer (EFT.) Direct Deposit is not available f5B. STARTCHANGE EFTSTOP EFT5C. 9 DIGIT ROUTING OR TRANSIT NUMBERACCOUNT TYPECHECKINGSAVINGSACCOUNT NUMBER5D. NAME OF FINANCIAL INSTITUTIONPART IV - MISCELLANEOUS INFORMATION Selected Value: 0 6. INFORMATION ON DEPENDENTS (COMPLETE THIS ITEM ONLY IF YOU SERVED BEFORE JANUARY 1, 1977 (or had a delayed entry before January 2, 1978) AND YOU CURRENTLY HAVE DEPENDENTS.)6A. ARE YOU CURRENTLY MARRIED?YES NO6B. DO YOU HAVE ANY CHILDREN WHO ARE: Selected Value: 0 (1) UNDER AGE 18 ORYES NO(2) OVER 18 BUT UNDER AGE 23, NOT MARRIED AND ATTENDING SCHOOL? ORYES NO(3) OF ANY AGE PERMANENTLY HELPLESS FOR MENTAL OR PHYSICAL REASONS?YES NO6C. IS EITHER YOUR FATHER OR MOTHER DEPENDENT UPON YOU FOR FINANCIAL SUPPORT?YES NOSubmit
