Form VA Form 22-8873 VA Form 22-8873 Supplemental Information for Change of Program or Reenro

OMB Approved No. 2900-0358
Respondent Burden: 30 Minutes

SUPPLEMENTAL INFORMATION FOR CHANGE OF PROGRAM OR REENROLLMENT
AFTER UNSATISFACTORY ATTENDANCE, CONDUCT OR PROGRESS
INSTRUCTIONS: Please furnish the information requested in Part I (Item 3) or Part II (Item 4) checked below. Disregard any item
not checked. Also attach any related information that you would like to have considered when VA evaluates your claim. If you need
more space for continuing your answer to an item, use the back of this form. Place your additional information in item 5, Remarks.
Alternately, attach a separate sheet of paper with your additional information to this form.
1. FIRST-MIDDLE-LAST NAME OF VETERAN OR ELIGIBLE PERSON

2. VA FILE NUMBER

PART I - CHANGE OF PROGRAM
3. YOU HAVE CHANGED YOUR EDUCATIONAL OBJECTIVE (PROGRAM). STATE WHY THIS NEW PROGRAM IS THE RIGHT PROGRAM FOR YOU.

PART II UNSATISFACTORY ATTENDANCE, CONDUCT OR PROGRESS
4. YOUR PREVIOUS SCHOOL STATED THAT YOUR ATTENDANCE, CONDUCT OR PROGRESS WAS UNSATISFACTORY. IF YOU NEED MORE SPACE FOR
YOUR INFORMATION, USE THE BACK OF THIS FORM OR ATTACH A SEPARATE PIECE OF PAPER.
A. STATE WHY YOU HAD UNSATISFACTORY ATTENDANCE, CONDUCT OR PROGRESS.

B. STATE WHAT STEPS OR PRECAUTIONS YOU HAVE TAKEN TO INSURE THAT THE UNSATISFACTORY ATTENDANCE, CONDUCT, OR
PROGRESS WILL NOT HAPPEN AGAIN.

C. STATE WHY THIS NEW PROGRAM IS THE RIGHT PROGRAM FOR YOU.

VA FORM
SEP 2006

22-8873

EXISTING STOCKS OF VA FORM 22-8873, SEP 2003,
WILL BE USED.

PART III - OTHER INFORMATION
5. REMARKS

I HEREBY CERTIFY THAT the statements contained herein are true and complete to the best of my knowledge
6. SIGNATURE OF APPLICANT

IMPORTANT

7. DATE

If you have already enrolled in an institutional program (college, university, technical school, etc.),
you should complete this form and give it to the Veterans Affairs office at your school. Your school
will complete VA Form 22-1999, Enrollment Certification (if not previously completed) and send all
this information to the appropriate VA Office. If you have not already enrolled in an institutional
program, you should complete and return this form to the VA office that sent it to you.

Respondent Burden: We need this information to determine your eligibility for additional educational benefits for a change of
program or reenrollment after unsatisfactory attendance, conduct or progress. (38 U.S.C. sections 3474, 3524 and 3691). Title 38,
United States Code, allows us to ask for this information. We estimate that you will need an average of 30 minutes to review the
instructions, find the information, and complete this 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
www.whitehouse.gov/omb/library/OMBINV.VA.EPA.html#VA. 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 this information collection.
Privacy Act Notice: VA will not disclose information collected on this form to any source other than what has been authorized
under the Privacy Act of 1974 or Title 38, Code of Federal Regulations 1.576 for routine uses as identified in the VA system of
records, 58VA21/22, Compensation, Pension, Education and Rehabilitation Records - VA, published in the Federal Register. An
example of a routine use allows the 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 the VA to obtain further
information as may be necessary from the school for the 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." While you do not have to respond,
VA cannot pay you any further education benefits until we receive the information. The responses you submit are considered
confidential (38 U.S.C. 5701). Any information provided by applicants, recipients, and others may be subject to verification through
computer matching programs with other agencies.