Military & Veteran Enrollment Services 2015-­‐16 Benefit Worksheet Name: For Chapters 30, 31, 35, 1606, 1607 and Post 9/11 (40-­‐90% tier, n on Yellow Ribbon) Social Security Number: Date of Birth: Permanent Mailing Address: Phone Number: Email Address: University ID Number: RIT Degree Program Name: Undergraduate Graduate COMPLETE ONLY THE SECTION BELOW THAT APPLIES TO YOU CONTINUNING RIT STUDENT: Complete this section if you are a student at RIT currently using VA benefits. Circle your affiliation: Veteran Active Duty Soldier Dependent Spouse Circle Chapter of Benefits: Post 9/11 30(MGIB) 31(Voc Rehab) 1606(SR) 1607(REAP) 35(DEA) Are you a spouse of an Active Duty soldier? Yes / No Has your RIT degree program changed within the last year? Yes / No Post 9/11 Recipients Only -­‐ Circle your p ercentage tier: 40% 50% 60% 70% 80% 90% VETERAN NEW TO RIT: Complete this section if you are a VETERAN applying to use benefits at RIT for the first time. Circle Chapter of Benefits: Post 9/11(non Yellow Ribbon) 30(MGIB) 31(Voc Rehab) 1606(SR) 1607(REAP) Post 9/11 Recipients Only -­‐ Circle your percentage tier: 40% 50% 60% 70% 80% 90% Branch of Service:________________________ Dates:____________________ Are you Active Duty? Yes / No If yes, will you be d ischarged before you begin at RIT? Yes / No Have you previously received VA benefits? Yes* / No If yes, list school:______________________________ *If you answered yes to the above question, you must also submit VA form 22-­‐1995 DEPENDENT/SPOUSE NEW TO RIT: Complete this section if you have been awarded benefits from a parent/spouse and are applying to use benefits at RIT for the first time. Circle the VA b enefit you are approved for: Post 9/11 (non Yellow Ribbon) OR Chapter 35, DEA Are you a spouse of an Active Duty soldier? Yes / No Have you previously received VA benefits? Yes* / No If yes, list school:_________________________________ Post 9/11 Recipients Only -­‐ Circle your percentage tier: 40% 50% 60% 70% 80% 90% Chapter 35 Recipients Only -­‐ Name & SSN of Veteran parent:_________________________________________ *If you answered yes , you must also submit VA form 22-­‐1995 or 22-­‐5495 FORECAST NUMBER OF CREDITS PER TERM Forecast the number of credit hours you will be completing during the 2015-­‐2016 school year. If exact amount is unknown, indicate Part-­‐time or Full-­‐time status. If you will be on CO-­‐OP, indicate if you would like to be certified for VA benefits during your CO-­‐OP. Fall(2151)__________ Intersession(2153)_______ Spring(2155)_________ Summer(2158)_______ CO-­‐OP Payment? Yes / No CO-­‐OP Payment? Yes / No CO-­‐OP Payment? Yes / No REVIEW AND SIGN Registration: Courses must be required within your RIT degree program in order to be certified for VA benefits. The MVES Office will automatically certify your registration for Fall, Spring & Summer terms. If you are registered for the Intersession, you must notify the MVES Office for certification of benefits. Any c hanges in course registration must be reported to MVES. Financial Aid: If you are also applying for Financial Aid or have been awarded an RIT scholarship, you must notify the Office of Financial Aid and Scholarships of your VA benefits to ensure proper coordination of all of your educational benefits. If you are eligible for NY Veteran Tuition Awards, NY National Guard or NY Naval Militia scholarships review www.rit.edu/military to initiate. Notice: Your RIT veteran records will be maintained in MVES to verify your veteran status with the Registrar, Financial Aid and Student Financial Services. Personal information will remain confidential and will be released only to the above departments as well as the US Office of Veteran Affairs. SIGNATURE:________________________________________________ Date:__________________________