Request for V.A. Educational Benefits

Please be aware that this is not an encrypted form. If this is a concern, please print form and mail to: Veterans Affairs Office, Eastern Kentucky University, SSB CPO 59, 521 Lancaster Avenue, Richmond, KY 40475-3159.

You must be registered for classes for the semester you are applying for benefits BEFORE filling out this form. This form must be filled out every semester.

Date
Name
Mailing Address
City
State
Zip Code
Phone
E-mail	Must have a valid EKU e-mail address

Everyone must provide either their social security number or an EKU I.D. number and a V.A. File Number. To learn about creating an EKU I.D. number, please go to: www.eku.edu/ekuid/

Social Security No.
EKU I.D. No.
V.A. File No

Your entitlements will be sent to the above address. If this information changes please contact the VA Regional Office at 1-888-442-4551.

Indicate below which chapter you receive:

	Chapter 30 (Active-Duty)
	Chapter 31 (Voc Rehab)
	Chapter 35 (Dependents of Deceased/Disabled Veterans)
	Chapter 1606 (Reserves/National Guard)
	Chapter 1607 (REAP)

MAJOR AND DEGREE CURRENTLY PURSUING

If this information has changed since your last request, you must complete a Change of Program form before benefits can be processed.

Below, designate term/year and credit hours that you are registered for. You may apply for benefits for any terms that you have pre-registered in.

TERM
YEAR
TOTAL HOURS
All classes listed for benefits must be required in either university studies, major program, or free/restricted electives as prescribed in the Eastern Kentucky University Catalog. This office uses the university CARES Report as basis for certification. Any changes in degree, prerequisite needs, or other changes in standard programs require written approval from college faculty and are the responsibility of the student to provide to this office. Classes must always reduce hours toward current degree goal. Therefore classes taken in audit status or other non-credit form cannot be certified. This form and any accompanying paperwork must be filled out and processed for all terms for which payment of benefits are requested. Persons who accept payments for which they are ineligible to receive may be subject to a charge of fraud and may be prosecuted by the Veterans Administration for the recovery of overpayment.

(If Chapter 30 or 1606 or 1607)

Do you get a kicker? (please indicate yes or no)

If so, what is the monthly amount?

Are you graduating this term? (please indicate yes or no)

Allow at least 6-8 weeks processing time