Grand View Veterans Services

All fields in bold are required.

Student Information
*
First name
Middle name
*
Last name
*
VA File Number: ss#
Are you a Chapter 35?
(see link below for definition)
Yes No
If yes, you must include Case File # (SSN)
Contact Information
*
Current Address
Street
City
State
Zip
VA Chapter
If you do not know what chapter you are/will be, click here. Then select Adult Learners and Military categories.
30 31 33 33 Yellow Ribbon 35 1606 1607
*
Current Semester I am currently enrolled in the semester.
Have you received benefits elsewhere? Yes No
If so, the last semester I was certified to the VA was .
Current Enrollment Information
Semester enrollment notification Fall Spring Summer semester for credit hours.
Change of program

I have changed my major. I am now enrolled in .
Please send me a VA Form 22-1995 - Required for Change of Program
OR fill out the online form.

  Change of address.
My new mailing address is:
Street
City
State
Zip
Deployment status

I received deployment orders on (date) . They require me to report for duty on (date) .

I am submitting a copy of my orders immediately to Assistant Registrar Marsha Pickett
bringing in person
mailing
sending by FAX to 515-263-6193
sending by third party

I understand you will process my "withdraw" status from both the university and the VA as soon as you receive orders.