VA Education Benefits Information Form
Student's Full Name
Student's Mailing Address
Student's Phone Number
Student's E-mail Address
Student's Date of Birth
Student's Social Security Number
If a Spouse or Dependent, what is the Veteran's name and social security number?
Which VA Education Benefit will you be using? (check all that apply)
Chapter 33- Post 9/11
Chapter 30- MGIB
Chapter 35- DEA
Chapter 31- VR&E
Chapter 1606- MGIB SR
WI GI Bill
WI National Guard Tuition Reimbursement
Not Sure
Are you enrolled in a "Shared Program" with another institution?
No
Yes, Lakeshore Technical College (LTC)
Yes, Mid-State Technical College (MSTC)
Yes, Southwest Technical College (SWTC)
If you are using Chapter 33, Post 9/11, benefits, what percent of eligibility do you have?
50%
60%
70%
80%
90%
100%
Not Sure
Do any of your classes require you to be off campus for a practicum or clinical?
Yes
No
Not Sure
Do you expect to get a scholarship that is designated for tuition only?
Yes
No
Have you ever used your VA Education benefits at another institution?
Yes
No
Do you have less than 12 months entitlement left?
Yes
No
Not Sure
You can upload your Certificate of Eligibility (COE) here.
You can upload your DD-214 here.
Contact Information