Benefits Request Form

VA Benefits Request Form

This form must be filled out each semester that you want to receive benefits.

If you see this don't fill out this input box.

* Full Name

* Student ID

* Primary Phone

* KCTCS Email

* Are you currently enrolled in classes?

YesNo

* Have you recently changed your major?

* Have you made a change to your course schedule for this semester?

VA Chapter

* Term Requesting

* Year Requesting

I am still an Active Guard/Reserve Service Member and am receiving Tuition Assistance from my unit:

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