Va Form 22-8691 - Application For Work-Study Allowance

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OMB Approved No. 2900-0209 Respondent Burden: 15 minutes APPLICATION FOR WORK-STUDY ALLOWANCE PART I - IDENTIFICATION INFORMATION (First, Middle, Last) 1. NAME OF APPLICANT (Number, and street or rural route, city or (For chapter 35, enter the veteran's file number. 2. MAILING ADDRESS OF APPLICANT 3A. VA FILE NUMBER P.O., State and 9 digit ZIP Code) Be sure to include the suffix indicator. For dependent's transfer of entitlement cases, enter the file number of the person who transferred entitlement to you) (If not shown in Item 3A) 3B. SOCIAL SECURITY NUMBER 3D. SEX OF APPLICANT (Month, Day, Year) 3C. DATE OF BIRTH OF APPLICANT 4B. PLEASE PROVIDE THE HOURS THAT VA CAN REACH YOU (Include Area Code) 4A. TELEPHONE NUMBER 5. EDUCATION BENEFIT RECEIVING (Post- 9/11 GI Bill) CHAPTER 33 (Montgomery GI Bill - Active Duty) (Dependents Educational Assistance) TRANSFER OF ENTITLEMENT CHAPTER 30 CHAPTER 35 (Parent or Spouse (Vocational Rehabilitation) (Montgomery GI Bill - Selected Reserve) CHAPTER 31 CHAPTER 1606 entitled to benefits) (Veterans Educational Assistance Program) (Reserve Educational Assistance Program) CHAPTER 32 CHAPTER 1607 PART II - SCHOOL INFORMATION 6A. NAME AND COMPLETE ADDRESS OF SCHOOL 6B. CURRENT ACADEMIC OR TRAINING PROGRAM 7. CURRENT ENROLLMENT INFORMATION 8. NEXT ENROLLMENT PERIOD YOU PLAN TO ATTEND A. BEGINNING DATE B. ENDING DATE A. BEGINNING DATE B. ENDING DATE (Month, Day, Year) (Month, Day, Year) (Month, Day, Year) (Month, Day, Year) PART III - WORK STUDY INFORMATION

9. ADVANCE PAYMENT - DO YOU WANT AN ADVANCE PAYMENT? (See instructions for information on advance payment on reverse under

"How Much Can I Earn?") (Tell us the school, VA facility or other government 10. HAVE YOU EVER PARTICIPATED IN THE VA WORK-STUDY 11. WORK SITE PREFERENCE facility where you would prefer to do VA related work. Be specific as many facilities (If "YES," please state where you worked) PROGRAM BEFORE? have the same name or perform the same services in different locations or cities.) Boise State Veteran Services (Tell us about the jobs you had before, 12. WORK EXPERIENCE 13. SPECIFY THE DAYS AND HOURS DURING THE WEEK YOU ARE AVAILABLE TO WORK other than VA work-study jobs. Please be as specific as possible. WHEN AVAILABLE (From & To) If you have no work experience, place "NONE" in this space. If needed, attach a separate sheet with your work-history)

(Tell us about any special qualifications you have based on your education or work experience. Include any experience in information

14. QUALIFICATIONS

technology. Also, tell us what kinds of jobs interest you. If needed, attach a separate sheet with this information)

(Do not print) 16. DATE SIGNED 15. SIGNATURE OF APPLICANT

PRIVACY ACT INFORMATION: VA will not disclose information collected by this information collection to any source other than what has been authorized by the Privacy Act of 1974 or

Title 38 Code of Federal Regulations 1.576 for routine uses as identified in VA's system of records, 58 VA 21/22/28, Compensation, Pension, Education and Vocational Rehabilitation Records -

VA as published in the Federal Register at An example of a routine use allows VA to send educational forms or letters with a veteran's

identifying information to the veteran's school or training establishment to (1) assist the veteran in the completion of claims forms or (2) for VA to obtain further information as may be necessary

from the school for VA to properly process the veteran's education claim or to monitor his or her progress during training. Your obligation to respond is "required to obtain or retain benefits". We

cannot pay you any work-study benefits until we receive this information (38 U.S.C. 3485). Your responses are confidential (38 U.S.C. 5701). Any information provided by applicants may be

subject to verification through computer matching programs with other agencies.

Respondent Burden: We need this information to determine your eligibility for VA work-study benefits. Title 38 United States Code allows us to ask for this information. We estimate that you

will need an average of 15 minutes to review the instructions, find the information, and complete the form. VA cannot conduct or sponsor a collection of information unless a valid OMB control

number is displayed. You are not required to respond to a collection of information if this number is not displayed. Valid OMB control numbers can be located on the OMB Internet page at

If desired, you can call 1-888-GI-BILL-1 (1-888-442-4551) to get information on where to send comments or suggestions about