Military&VeteranEnrollmentServices
2016-17VABenefitWorksheet
Name: ForbeneficiariesofChapters30(MGIB),31(VocRehab),35(DEA),1606(Reservist),andPost
9/11(40-90%tieronly).
SocialSecurityNumber:DateofBirth:
PermanentMailingAddress:PhoneNumber:
EmailAddress:
UniversityIDNumber:RITDegreeProgramName:Undergraduate
Graduate
COMPLETEONLYTHESECTIONBELOWTHATAPPLIESTOYOU
CONTINUINGRITSTUDENT:CompletethissectionifyouareastudentatRITcurrentlyusingVAbenefits.
Circleyouraffiliation:Veteran/Servicemember
ActiveDutySoldierDependentSpouse
CircleChapterofBenefits:Post9/1130(MGIB)31(VocRehab)1606(SR)35(DEA)
AreyouaspouseofanActiveDutysoldier?Yes/No
HasyourRITdegreeprogramchangedwithinthelastyear?Yes/No
Post9/11RecipientsOnly-Circleyourpercentagetier:40%50%60%70%80%90%
VETERAN/SERVICEMEMBERNEWTORIT:IfyouareapplyingtousebenefitsatRITforthefirsttime…
CircleChapterofBenefits:Post9/11(nonYellowRibbon)30(MGIB)31(VocRehab)1606(SR)
Post9/11RecipientsOnly-Circleyourpercentagetier:40%50%60%70%80%90%
BranchofService:________________________Dates:____________________
AreyouActiveDuty?Yes/NoIfyes,willyoubedischargedbeforeyoubeginatRIT?Yes/No
HaveyoupreviouslyreceivedVAbenefits?Yes/NoIfyes,youmustsubmitVAform22-1995
Ifyes,listpriorcollege:_______________________________PublicorPrivateCollege?_________________
DEPENDENT/SPOUSENEWTORIT:Completethissectionifyouhavebeenawardedbenefitsfromaparent/spouse
andareapplyingtousebenefitsatRITforthefirsttime.
CircletheVAbenefityouareapprovedfor:Post9/11(nonYellowRibbon)ORChapter35,DEA
AreyouaspouseofanActiveDutysoldier?Yes/No
HaveyoupreviouslyreceivedVAbenefits?Yes/NoIfyes,youmustsubmitVAform22-1995or22-5495
Ifyes,listcollege:__________________________________PublicorPrivatecollege?_________________
Post9/11RecipientsOnly-Circleyourpercentagetier:40%50%60%70%80%90%
Chapter35RecipientsOnly-Name&SSNofVeteranparent:_________________________________________
FORECASTNUMBEROFCREDITSPERTERMANDIFYOUWANTPAYMENTDURINGCO-OP
IndicateifyouplantobePart-time(PT),Full-time(FT),onCo-OporNotAttending(NA)duringeachtermbelow.
Fall(2161):PT/FT/Co-Op Spring(2165):PT/FT/Co-OpSummer(2168):PT/FT/Co-Op/NA
Co-OpPayment?*Yes/No
*DuringCo-Op,youcanchoosetouseyourentitlementinordertoreceiveyourmonthlystipend.Co-Opcertificationwillreduceyourtotalmonthly
entitlementjustasanyothertermcertificationwould.
REVIEWANDSIGN
Registration:CoursesmustberequiredwithinyourRITdegreeprograminordertobecertifiedforVAbenefits.Anychangesincourseregistrationmust
bereportedtoMVES.
FinancialAid:YouareencouragedtocontacttheOfficeofFinancialAidandScholarshipsforadditionalfundingresources.IfyouapplyforFinancialAidor
havebeenpreviouslyawardedanaidpackage,youmustnotifytheOfficeofFinancialAidandScholarshipsofyourVAbenefitstoensureproper
coordinationofallofyoureducationalbenefits.IfyouareeligibleforNYVeteranTuitionAwards,NYNationalGuardorNYNavalMilitiascholarships
reviewwww.rit.edu/militarytoinitiate.
Notice:YourRITveteranrecordswillbemaintainedinMVEStoverifyyourveteranstatuswiththeRegistrar,FinancialAidandStudentFinancialServices.
PersonalinformationwillremainconfidentialandwillbereleasedonlytotheabovedepartmentsaswellastheUSOfficeofVeteranAffairs.
SIGNATURE:________________________________________________Date:__________________________