Complete the New Veteran Information form Link

Iowa Central Community College
Veterans Services Information Form
Name:_____________________________________________________Student ID #:________________
Address:______________________________________________________________________________
Phone Number: ________________________________ Social Security #:_________________________
Email Address:_________________________________________________________________________
Have you attended a previous school?
Have you used your Military Benefits at a previous school?
Yes
Yes
No
No
*(Application 22-1995 Change of Place/Program will need to be completed for changing schools
or 22-5495 for Chapter 35 students)
All transcripts from previous schools including Military transcripts need to be sent to Iowa Central prior
to certification being complete.
Please list prior schools:_________________________________________________________________
Branch of Service:______________________________________________________________________
Current Active Duty:
Current Military:
Retired:
Honorable Discharge:
Yes
Yes
Yes
Yes
No
No
No
No
Which GI Bill will you be using:
______1606
______33 _________ Chapter 33 %
______1607
______31 ___________________________________VA Counselor’s Name
______30
______35 ___________________________________Military Member’s SS#
Current Major at Iowa Central:____________________________________________________________
Items needed to use benefits at Iowa Central Community College:
1.
2.
3.
4.
5.
Certificate of Eligibility
a. Copy of application confirmation will work until Certificate of Eligibility arrives.
Copy of Kicker Addendum if applicable
Copy of most recent DD-214
Request for 22-1999 (Enrollment Certification) completed every term enrolled
Enrolled in classes at Iowa Central Community College