Current Start Confirm & Submit Complete Form 816 - VA Educational Benefits Request Name First Middle Last Suffix Mailing Info Address City/Town - Select -AlabamaAlaskaAmerican SamoaArizonaArkansasArmed Forces (Canada, Europe, Africa, or Middle EastArmed Forces AmericasArmed Forces PacificCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFederate States of MicronesiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarshall IslandsMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPalauPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirgin IslandsVirginiaWashingtonWest VirginiaWisconsinWyoming State/Province ZIP/Postal Code Email Address Student ID number Date of Birth Last Four of Social Security # XXX-XX- Primary Telephone Secondary Telephone Academic Information Academic Program - Select -Accounting & FinanceAgricultural Systems TechnologyAir Conditioning, Heating & Refrigeration TechnologyArchitectural TechnologyAssociate in ArtsAssociate in EngineeringAssociate in Fine Arts: Visual ArtAssociate in ScienceAutomotive Systems TechnologyBaking & Pastry ArtsBiotechnologyBuilding Automation TechnologyBusiness AdministrationBusiness AnalyticsCivil Engineering TechnologyCloud InfrastructureCollision Repair & Refinishing TechnologyComputed TomographyComputer Programming & DevelopmentConstruction Equipment Systems TechnologyConstruction Management TechnologyCosmetologyCriminal Justice TechnologyCulinary ArtsCybersecurityData Science & Programming Support ServicesDental AssistingDental HygieneDiesel & Heavy Equipment TechnologyEducationElectrical Systems TechnologyElectronics Engineering TechnologyEmergency Medical ScienceEsthetics TechnologyFacility Maintenance TechnologyGeomatics Technology (Surveying)Graphic DesignHealth & Fitness ScienceHeavy Equipment & Transport TechnologyHospitality ManagementHuman Services TechnologyInterior DesignIT Service & SupportMagnetic Resonance ImagingMammographyMechanical Engineering TechnologyMedical AssistingMedical Laboratory TechnologyMedical Office AdministrationNetwork ManagementNeurodiagnostic TechnologyNursingOffice AdministrationParalegal TechnologyPharmacy TechnologyPlumbingPractical NursingPublic Safety AdministrationRadiographyRespiratory TherapySimulation & Game DevelopmentSonographySupply Chain ManagementWeb & UX DesignWeb DeveloperWelding Technology Term Year Military Service VA File Number (For dependents only.) VA Eligibility Please check education benefit you are eligible for. Chapter 33: Post-9/11 Chapter 33: Post-9/11 - Transfer of Entitlement (TOE) Fry Scholarship Chapter 30: Montgomery GI Bill Chapter 31: VA Vocational Rehabilitation Chapter 35: Dependent/Survivor Assistance Chapter 1606: Selected Reserve/Guard Chapter 1607: REAP Tuition Assistance Will you receive Tuition Assistance from the military? Yes No Former/Present Military or Reserve Branch - Select -ArmyNavyAir ForceMarinesCoast Guard Currently on Active Duty? Yes No Discharge Date Indicate the date of your discharge. Payment Preferences Advance Payment Request Yes No Note: Advance payment is not an option for Post-9/11 GI Bill. ** Advance Payment requests must be submitted to the Military & Veteran Services Department at least six weeks before the start of the term. The VA reserves the right to reject any Advance Payment requests. I acknowledge the information provided is accurate. Should any information change, I will notify the Military & Veterans Services Department in writing. I agree to adhere to policies and procedures set forth by both the U.S. Department of Veterans Affairs and Wake Technical Community College. I will comply with VA and college regulations regarding course drops and withdrawals and termination of registration. I understand, if applicable, I must verify attendance at the end of each month. I understand enrollment information will not be submitted to the VA until I am registered for courses. I understand I will not be paid for courses not in my curriculum. I understand I will not be paid for courses challenged or audited. I understand I will not be paid for remediation and academic support courses taught online. Signature Date
