This form must be completed and submitted each semester you plan on using VA Educational Benefits

AU ID:

AU E-MAIL ADDRESS:

DEMOGRAPHIC INFORMATION

FIRST NAME:

MIDDLE NAME:

LAST NAME:

Address

MILITARY INFORMATION
***Please Note:  In order to qualify to participate in the Yellow Ribbon Program, you must be 100% eligible for the CH. 33 Post 9/11 GI BILL. You must either be a veteran, or dependent who has been awarded, or transferred over the CH. 33 Post 9/11 GI BILL, and not currently serving on active duty, or be a spouse of an active duty service member. You must also adhere to all university guidelines and be in good academic standing. If you have any questions about your status, please contact Veterans Services: (202) 885-8018 or veterans@american.edu
ENROLLMENT INFORMATION

NUMBER OF CREDIT(S) REGISTERED FOR THIS SEMESTER:

LIST MAJOR:

ARE YOU AN AMERICAN UNIVERSITY EMPLOYEE?

IF YES, ARE YOU RECEIVING TUITION REMISSION?

ARE YOU AN ACTIVE DUTY SERVICE MEMBER RECEIVING TUITION ASSISTANCE FROM AN OUTSIDE AGENCY OR EMPLOYER?

IF YES, PLEASE LIST NAME(S) OF AGENCY/EMPLOYER?

ARE YOU RECEIVING ANY OUTSIDE SCHOLARSHIP(S)?

IF YES, PLEASE NOTIFY AU CERTIFYING OFFICIAL AS TO WHETHER YOUR SCHOLARSHIP(S) IS/ARE RESTRICTED TO TUITION AND FEES:

T