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Office of Veterans Affairs
YSU Semester VA Benefit Declaration Form
YSU Semester VA Benefit Declaration Form
Current
Start
(This form is NOT COMPLETE, please read and initial each statement on reverse side, sign and date)
Complete
Intro
Fill out all appropriate blocks below and initial by each statement.
Last, First, MI
YSU ID Number
Address
Include all information pertaining to your address; i.e., house number, street, AND City, State, Zip Code
Phone Number
Non-YSU Email
Major
Undergraduate or Graduate
Projected Graduation Date:
I wish to use VA education benefits for (list semester/year)
Indicate the VA education benefit you are entitled to (contact the Office of Veterans Affairs if unsure)
CH 1606/1607 Montgomery Reserve – National Guard/Reservists
CH 30 Montgomery – Active Duty/ Veterans
CH 31 Vocational Rehab - Veterans with disabilities of 30% or higher
CH 33 Post 911 - Active Duty/Veterans (Includes Edith Nourse STEM Scholarship)
CH 33 Post 911 Transferred Benefits – Dependents
CH 35 Dependent Education Assistance (DEA) – Eligible spouses and children
Fry Scholarship
Months/Days of VA benefit remaining: (Not Mandatory)
I plan to use the following DOD/State education benefits this semester:
Tuition Assistance (TA). List branch of service _________________________ (submit approved TA form to the Veterans Resource Center)
Ohio National Guard Scholarship – Deadlines to apply: 1 Jul (Fall), 1 Nov (Spring), 1 Apr (Summer)
Ohio War Orphan Scholarship – Deadline to apply: May 1 of the previous school year
No additional DOD/State education benefits being used this semester
Courses to be certified:
Subj/Crse#:_____(Ex: Hist 1501)______Cred hrs: 3______Online/On-Campus/ Internship/TA :____(Ex: Online)
Leave this field blank
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