YSU Semester VA Benefit Declaration Form

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Fill out all appropriate blocks below and initial by each statement.

Include all information pertaining to your address; i.e., house number, street, AND City, State, Zip Code

I wish to use VA education benefits for...(select semester/year below)

Indicate the VA education benefit you are entitled to (contact the Office of Veterans Affairs if unsure)
I plan to use the following DOD/State education benefits this semester:
Subj/Crse#:_____(Ex: Hist 1501)______Cred hrs: 3______Online/On-Campus/ Internship/TA :____(Ex: Online)