Va Form 22 1995 is a document that all veterans should have in their possession. This form is used to apply for Veterans Affairs (VA) benefits, and it is important to understand how to complete it correctly in order to receive the benefits you deserve. In this blog post, we will provide an overview of Va Form 22 1995 and explain how to fill out each section correctly. Completing this form can be difficult, so if you need assistance, please contact a VA representative for help.
The listing has got information regarding the va form 22 1995. It's advisable that you read through this information before you start editing the form.
Question | Answer |
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Form Name | Va Form 22 1995 |
Form Length | 4 pages |
Fillable? | No |
Fillable fields | 0 |
Avg. time to fill out | 1 min |
Other names |
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OMB Control No. |
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Respondent Burden: 20 Minutes |
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Expiration Date: 10/31/2021 |
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REQUEST FOR CHANGE OF PROGRAM OR PLACE OF TRAINING |
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PART I - IDENTIFICATION AND PERSONAL INFORMATION |
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1A. NAME OF APPLICANT (Last, First, Middle) |
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VA DATE STAMP |
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DO NOT WRITE IN THIS SPACE |
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1B. MAILING ADDRESS (Complete street address, City, State, and |
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1C. APPLICANT'S TELEPHONE NUMBER (Including Area Code) |
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1D. VA FILE NUMBER |
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HOME (include area code) |
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MOBILE (include area code) |
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1F. SOCIAL SECURITY OF APPLICANT (For transferability cases, |
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1E. APPLICANT'S |
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enter the veteran's social security number) |
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PART II - YOUR PROGRAM INFORMATION |
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2. EDUCATION BENEFIT YOU WANT TO RECEIVE (Only Select One) |
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CHAPTER 33 |
C. |
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CHAPTER 32 (Veterans Educational Assistance |
E. |
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TRANSFER OF ENTITLEMENT PROGRAM |
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A. |
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Program including section 903) |
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CHAPTER 30 (Montgomery GI Bill - |
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CHAPTER 1606 (Montgomery GI Bill- |
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B. |
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D. |
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Active Duty) |
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Selected Reserve) |
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3. HOW WILL YOU TAKE TRAINING? |
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SCHOOL ATTENDANCE |
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G. |
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LICENSING & CERTIFICATION TEST |
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A. |
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D. |
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COOPERATIVE TRAINING |
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NATIONAL ADMISSIONS EXAMS OR |
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B. |
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CORRESPONDENCE |
E. |
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TUITION ASSISTANCE |
H. |
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(Active Duty Only) |
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NATIONAL EXAMS FOR CREDIT |
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APPRENTICESHIP OR |
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C. |
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F. |
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FLIGHT TRAINING |
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TRAINING |
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4A. WHAT EDUCATIONAL, PROFESSIONAL OR VOCATIONAL GOAL ARE |
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4B. WHAT IS THE NAME OF THE PROGRAM YOU ARE REQUESTING? |
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YOU WORKING TOWARD? |
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4C. IF CHANGING SCHOOLS, PROVIDE NAME AND COMPLETE ADDRESS |
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4D. PROVIDE NAME AND COMPLETE ADDRESS OF PREVIOUS SCHOOL OR |
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OF NEW SCHOOL OR TRAINING ESTABLISHMENT YOU ARE PLANNING |
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TRAINING ESTABLISHMENT (If only changing schools, list current school.) |
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TO ATTEND (If applicable) |
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4E. TELL US WHEN AND WHY YOU STOPPED TRAINING AT YOUR PRIOR SCHOOL OR ESTABLISHMENT. CONTINUE IN REMARKS, ITEM 10, OR ON A SEPARATE |
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SHEET IF NECESSARY. (If applicable) |
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VA FORM |
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SUPERSEDES VA FORM |
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Page 1 |
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JUL 2020 |
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WHICH WILL NOT BE USED. |
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PART III - DIRECT DEPOSIT INFORMATION
5.DIRECT DEPOSIT (Complete this item only if you wish to start, change or stop direct deposit.) (See Instructions and Information, Page 3, Item number 5 for additional information regarding direct deposit.)
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 for the
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START OR CHANGE EFT (Please attach a voided personal check or provide the information in items 5A through 5D below.) |
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STOP EFT |
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5A. TYPE OF ACCOUNT |
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CHECKING |
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SAVINGS |
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5B. NAME OF FINANCIAL INSTITUTION |
5C. 9 DIGIT ROUTING OR TRANSIT NUMBER |
5D. ACCOUNT NUMBER |
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PART IV - MISCELLANEOUS INFORMATION
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.)
QUESTIONS |
YES |
NO |
6A. ARE YOU CURRENTLY MARRIED?
6B. DO YOU HAVE ANY CHILDREN WHO ARE:
(1) UNDER AGE 18 OR
(2) OVER 18 BUT UNDER AGE 23, NOT MARRIED AND ATTENDING SCHOOL? OR
(3) OF ANY AGE PERMANENTLY HELPLESS FOR MENTAL OR PHYSICAL REASONS?
6C. IS EITHER YOUR FATHER OR MOTHER DEPENDENT UPON YOU FOR FINANCIAL SUPPORT?
7.RECENT PERIODS OF SERVICE (PERIODS OF ACTIVE DUTY SINCE YOUR INITIAL PERIOD OF ACTIVE DUTY.) Please complete this section for each period of your active duty since your initial period of active duty if you have not previously reported this information. It will help VA process your claim if you attach a certified copy of "Member 4 Copy" of your DD Form 214 for each period of active service. (Don't report Active Duty for Training.)
7A. BRANCH OF SERVICE AND RESERVE OR GUARD COMPONENT SERVED IN DURING ACTIVE DUTY
7B. BEGINNING AND ENDING
DATES OF ACTIVE DUTY
7C. WERE YOU
INVOLUNTARILY CALLED TO
ACTIVE DUTY FOR THIS PERIOD? (If yes send in
copies of your orders)
YES |
NO |
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7D. WHAT WAS THE CHARACTER
OF YOUR DISCHARGE?
7E. IF THIS ACTIVE DUTY IS
NATIONAL GUARD DUTY, INDICATE
IF AUTHORITY IS TITLE 10
(FEDERAL) OR TITLE 32 (STATE).
(ATTACH COPIES OF ANY ORDERS)
NOTE: DO NOT INCLUDE FULL TIME ASSIGNMENT BY A SERVICE DEPARTMENT TO A CIVILIAN SCHOOL FOR A COURSE OF EDUCATION; ATTENDANCE AT A SERVICE ACADEMY; OR
8.DO YOU EXPECT TO RECEIVE EDUCATIONAL BENEFITS UNDER THE GOVERNMENT EMPLOYEE'S TRAINING ACT (GETA) FOR THE SAME COURSE(S) YOU WILL RECEIVE VA EDUCATION BENEFITS? (Answer only if you are a Federal Government employee)
YES
NO
9.ARE YOU RECEIVING OR DO YOU ANTICIPATE RECEIVING ANY MONEY (including but not limited to Federal Tuition Assistance) FROM THE ARMED FORCES OR PUBLIC HEALTH SERVICE FOR THE COURSE FOR WHICH YOU HAVE APPLIED TO VA FOR EDUCATION BENEFITS? IF YOU WILL RECEIVE SUCH BENEFITS, CHECK "YES." SHOW COMPLETE DETAILS IN THE REMARKS SECTION TO INCLUDE THE SOURCE OF THE FUNDS. NOTE: IF YOU ARE APPLYING FOR THE TUITION ASSISTANCE
YES
NO
10. REMARKS
PART V - CERTIFICATION AND SIGNATURE OF APPLICANT
I CERTIFY THAT all statements in my application are true and correct to the best of my knowledge and belief. If on active duty, I also certify that I have consulted with an Education Service Officer (ESO) regarding my education program.
PENALTY - Willful false statements as to a material fact in a claim for education benefits is a punishable offense and may result in the forfeiture of these or other benefits and in criminal penalties.
11A. SIGNATURE OF APPLICANT (DO NOT PRINT)
SIGN HERE IN INK
11B. DATE SIGNED
VA FORM |
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INSTRUCTIONS & INFORMATION
When Should You Use This Form?
Use this form when:
•you're changing schools,
•you're changing your educational, professional, vocational goal,
•you left your program due to unsatisfactory attendance, progress, or conduct; and you're now reentering the same program,
•you were receiving VA education benefits as a veteran and now wish to receive benefits while on active military duty.
INSTRUCTIONS FOR SPECIFIC ITEMS ON THE FORM
Most items on this form are
Item #4A: Here are some examples of what we mean by "goals":
•Educational goal: GED certificate, high school diploma, bachelor's degree, master's degree, Ph.D
•Professional goal: lawyer, physician, teacher, physical therapist, medical technologist, medical records librarian, stenographer, machinist, electronic technician,
•Vocational goal: TV service technician, automobile mechanic, practical nurse.
Item #5: The Department of the Treasury requires all Federal benefit payments be made by electronic funds transfer (EFT), also called direct deposit (Direct Deposit is not available for Chapter 32 recipients). To enroll in direct deposit, please attach a voided personal check, deposit slip, or provide the information requested in Item 5. If you do not have a bank account, please visit https://www.benefits.va.gov/benefits/banking.asp. This website provides information about the Veterans Benefits Banking Program (VBBP), and a link to banks and credit unions that may fit your needs. You may also call
Item #6: Provide your dependents' information only if you have military service before January 1, 1977 (or delayed entry before January 2, 1978).
Item #6A: IMPORTANT: If you are certifying that you are married for the purpose of VA benefits, your marriage must be recognized by the place where you and/or your spouse resided at the time of marriage, or where you and/or your spouse resided when you filed your claim (or a later date when you become eligible for benefits) (38 U.S.C. § 103(c)). Additional guidance on when VA recognizes marriages is available at http://www.va. gov/opa/marriage/.
If You Need Help
If you need help in completing this form, you can contact us through our home page on the Internet. Our website is: www.benefits.va.gov/gibill. Click on the "Contact Us" tab and then the "Ask a Question" tab. Or you may call us toll free at
TO FILE THIS FORM:
(A) If you have selected a school or training establishment,
Step1: Mail the completed form to the VA Regional Processing Office in the region of that school's or establishment's physical address. Determine the correct office from the list on page 4.
Step 2: Notify the veterans certifying official at your school or training establishment that you have applied for VA education benefits. Ask him or her to submit your enrollment information using VA Form
Step 3: Wait for VA to process your application and notify you of our decision concerning your continued eligibility for educational assistance.
(B)If you have not selected a school or training establishment,
Step 1: Mail the completed form to the VA Regional Processing Office in the region of your home address. Determine the correct office from the list on page 4.
Step 2: Wait for VA to process your application and notify you of our decision concerning your continued eligibility for educational assistance.
VA FORM |
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Eastern Region:
VA Regional Office
P. O. Box 4616
Buffalo, NY
SERVES THE FOLLOWING STATES
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CO |
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DC |
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DE |
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IA |
IL |
IN |
KS |
KY |
MA |
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MD |
ME |
MI |
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MN |
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MO |
MT |
NC |
ND |
NE |
NH |
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NJ |
NY |
OH |
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PA |
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RI |
SD |
TN |
VA |
VT |
WI |
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WV |
WY |
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APO/FPO AA |
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FOREIGN |
U.S. VIRGIN ISLANDS |
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SCHOOLS |
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Western Region:
VA Regional Office
P.O. Box 8888
Muskogee, OK
SERVES THE FOLLOWING STATES
AK |
AL |
AR |
AZ |
CA |
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FL |
GA |
HI |
ID |
LA |
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MS |
NM |
NV |
OK |
OR |
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PR |
SC |
TX |
UT |
WA |
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APO/FPO AP |
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GUAM |
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PHILIPPINES |
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REQUEST TO OPT OUT OF INFORMATION SHARING WITH EDUCATIONAL INSTITUTIONS:
The Harry W. Colmery Veterans Educational Assistance Act of 2017 (Public Law
PRIVACY ACT NOTICE: The VA will not disclose information collected on this form to any source other than what has been authorized under the Privacy Act of 1974 or title 38, Code of Federal Regulations, section 1.526 for routine uses (e.g. VA sends educational forms or letters with a veteran's identifying information to the veteran's school or training establishment to (1) assist the veteran in the completion of claims forms or (2) for the VA to obtain further information as may be necessary from the school for the VA to properly process the veteran's education claim or to monitor his or her progress during training) as identified in the VA system of records, 58VA21/22/28, Compensation, Pension, Education and Veteran Readiness and Employment Services - VA, published in the Federal Register. Your obligation to respond is required to obtain or retain education benefits. The requested information is considered relevant and necessary to determine the maximum benefits under the law. While you do not have to respond, VA cannot process your claim for education assistance unless the information is furnished as required by existing law (38 U.S.C. 3471). The responses you submit are considered confidential (38 U.S.C. 5701). Any information provided by applicants, recipients, and others may be subject to verification through computer matching programs with other agencies.
RESPONDENT BURDEN: We need this information to determine your continued eligibility to VA education benefits (38 U.S.C. 3471). Title 38, United States Code, allows us to ask for this information. We estimate that you will need an average of 20 minutes to review the instructions, find the information, and complete this form. VA cannot conduct or sponsor a collection of information unless a valid OMB control number is displayed. You are not required to respond to a collection of information if this number is not displayed. Valid OMB control numbers can be located on the OMB Internet Page at http://www.reginfo.gov/public/do/PRAMain. If desired, you can call
VA FORM |
Page 4 |