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

AU ID:

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DEMOGRAPHIC INFORMATION

FIRST NAME:

LAST NAME:

MILITARY INFORMATION
ENROLLMENT INFORMATION

LIST MAJOR: (Example: BS, Underwater Basket Weaving)

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:

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?

NUMBER OF CREDIT(S) REGISTERED FOR THIS SEMESTER:

ARE YOU AN AMERICAN UNIVERSITY EMPLOYEE?

IF YES, ARE YOU RECEIVING TUITION REMISSION?

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