Grand View Veterans/Military Services

All fields in bold are required.

Student Information
*
First name

Middle name

*
Last name

VA File Number

Gender

Female
Male

*
Date of Birth

Contact Information
*
Current Address
Street
City
State
Zip


Permanent Address
if different from above
Street
City
State
Zip


Home Phone
(xxx-xxx-xxxx)


Cell Phone
(xxx-xxx-xxxx)


*
Email

Enrollment Information
I will be a … Freshman
Transfer
Readmit


Term of Anticipated Enrollment Fall
Spring
Summer

Year

Academic Program 1

Academic Program 2

Military Information
What is your current military status? Active Duty
National Guard
Reserve
Military Spouse
Other Military Dependent (non-spouse)
Veteran
Veteran Spouse
Other Veteran Dependent (non-spouse)


Indicate which benefits you intend to use (select all that apply)

Military Tuition Assistance
Post 9/11 GI Bill (Chapter 33)
Montgomery GI Bill (Chapter 30)
Other VA/Beteran Education Benefits

I do not intend to use military or veteran education benefits


Have you received benefits elsewhere? Yes No
If so, institution you attended while receiving benefits:
If so, the last semester I was certified to the VA was