Military&VeteranEnrollmentServices
2016-2017Post9/11,100%tier&YellowRibbonWorksheet
andFryScholarshiprecipientsdonotqualifyforYellowRibbonfunding.
31233221
Name: ThisformshouldbecompletedbyPost9/11,100%tierbeneficiaries.Note:Activedutysoldiers,theirspouses
SocialSecurityNumber:DateofBirth:
PermanentMailingAddress:PhoneNumber: EmailAddress:
UniversityIDNumber:RITDegreeProgramName:Undergraduate
Graduate
COMPLETEONLYTHESECTIONBELOWTHATAPPLIESTOYOU
CONTINUINGRITSTUDENT:IfyouareastudentatRITcurrentlyusingVAbenefits…
Circleyouraffiliation:Veteran/ServicememberActiveDutySoldierDependentSpouse
AreyoueligibleforPost9/11atthe100%tier?Yes/No
HasyourRITdegreeprogramchangedwithinthelastyear?Yes/No
AreyouaspouseofanActiveDutysoldier?Yes/No
VETERAN/SERVICEMEMBERNEWTORIT:IfyouareapplyingtousebenefitsatRITforthefirsttime…
AreyouapprovedforPost9/11VABenefitsatthe100%tier?Yes/No
BranchofService:____________________________Dates:______________________
AreyouActiveDuty?Yes/No
Ifyes,willyoubedischargedbeforeyoubeginatRIT?Yes/No
HaveyoupreviouslyreceivedVAbenefits?Yes/NoIfyes,youmustsubmitVAform22-1995
Ifyes,listcollege:__________________________________PublicorPrivateCollege?_________________
DEPENDENT/SPOUSENEWTORIT:Ifyouhavebeenawardedbenefitsfromaparent/spouseandareapplyingtouse
benefitsatRITforthefirsttime…
AreyouapprovedforPost9/11VABenefitsatthe100%tier?Yes/No
Circleyouraffiliation:DependentorSpouseAreyouaspouseofanActiveDutysoldier?Yes/No
HaveyoupreviouslyreceivedVAbenefits?Yes/NoIfyes,youmustsubmitVAform22-1995
Ifyes,listpriorcollege:__________________________________PublicorPrivatecollege?________________
FORECASTNUMBEROFCREDITSPERTERMANDIFYOUWANTPAYMENTDURINGCO-OP
IndicateifyouplantobePart-time(PT),Full-time(FT),onCo-OporNotAttending(NA)duringeachtermbelow.
Fall(2161):PT/FT/Co-Op Spring(2165):PT/FT/Co-OpSummer(2168):PT/FT/Co-Op/NA
Co-OpPayment?*Yes/No
*DuringCo-Op,youcanchoosetouseyourentitlementinordertoreceiveyourhousingstipend.Co-Opcertificationwillreduceyour
totalmonthlyentitlementjustasanyothertermcertificationwould.
REVIEWANDSIGN
Registration:CoursesmustberequiredwithinyourRITdegreeprograminordertobecertifiedforVAbenefits.Anychangesincourseregistrationmust
bereportedtoMVES.
FinancialAid:YouareencouragedtocontacttheOfficeofFinancialAidandScholarshipsforadditionalfundingresources.IfyouapplyforFinancialAidor
havebeenpreviouslyawardedanaidpackage,youmustnotifytheOfficeofFinancialAidandScholarshipsofyourVAbenefitstoensureproper
coordinationofallofyoureducationalbenefits.IfyouareeligibleforNYVeteranTuitionAwards,NYNationalGuardorNYNavalMilitiascholarships
reviewwww.rit.edu/militarytoinitiate.
Notice:YourRITveteranrecordswillbemaintainedinMVEStoverifyyourveteranstatuswiththeRegistrar,FinancialAidandStudentFinancialServices.
PersonalinformationwillremainconfidentialandwillbereleasedonlytotheabovedepartmentsaswellastheUSOfficeofVeteranAffairs.
SIGNATURE:________________________________________________Date:__________________________