Form VA Form 22-0839 VA Form 22-0839 Yellow Ribbon Program Agreement

OMB Control No. 2900-0718
Respondent Burden: 10 minutes

YELLOW RIBBON PROGRAM AGREEMENT
(Under chapter 33 of title 38, United States Code)
NAME OF INSTITUTION OF HIGHER LEARNING

ADDRESS OF INSTITUTION OF HIGHER LEARNING

FACILITY CODE

Date Received (For VA use only)

The above named institution of higher learning (IHL) agrees to participate in the Yellow Ribbon Program under the
Post-9/11 GI Bill (authorized under title V of Public Law 110-252) subject to the terms, conditions, and representations
provided in this agreement and applicable VA regulations.
1. The IHL agrees to provide contributions to eligible individuals who apply for such program at the institution (in a
manner prescribed by the institution) on a first-come-first-served basis, regardless of the rate at which the individual is
pursuing training (i.e., full-time versus less than full-time), during the academic year.
2. The IHL agrees to provide contributions on behalf of a participating individual during the current academic year and all
subsequent academic years in which the IHL participates in the Yellow Ribbon Program, provided that the individual
maintains satisfactory progress, conduct, and attendance according to the regularly prescribed standards of the
institution.
3. The IHL agrees to limit contributions made on behalf of a participant to funds under the unrestricted control of the IHL
(e.g., a scholarship sent directly to an IHL on behalf of an individual or specific group of individuals from a third
party may not be included in Yellow Ribbon Program contributions). Funds received directly or indirectly from
Federal sources may not be counted towards contributions.
4. The IHL agrees to provide the maximum amount of contributions payable toward the unmet established charges to
each participating individual during each term, quarter, or semester the individual is enrolled if the IHL’s total
contribution toward the individual’s unmet established charges for the term, quarter, or semester do not exceed the
maximum dollar amount payable during the academic year as specified in paragraph 7 of this agreement.
5. The IHL agrees to provide contributions for each Yellow Ribbon Program participant using the following:
Direct Grant
Scholarship
Other_________________________
6. The IHL agrees to provide Yellow Ribbon Program contributions to up to__________ eligible individuals during
(number)
the academic year.
7. The IHL agrees to provide Yellow Ribbon Program contributions for each participant during the academic year up
to the following amounts (as specified in one of the following subparagraphs):
a. $____________ for each student; or
b. $____________ for each undergraduate student,
$____________ for each graduate student, and
$____________ for each doctoral student, or
c. $____________ for each student enrolled in the following college or professional school_______________________
$____________ for each student enrolled in the following college or professional school_______________________
$____________ for each student enrolled in the following college or professional school_______________________
$____________ for each student enrolled in the following college or professional school_______________________
$____________ for each student enrolled in the following college or professional school_______________________
$____________ for each student enrolled in the following college or professional school_______________________
$____________ for each student enrolled in the following college or professional school_______________________
(Attach additional listings if necessary)
VA FORM
NOV 2008

22-0839

(Continued on Reverse)

8. An IHL with multiple campuses that wishes to submit a single Yellow Ribbon Program agreement covering more
than one campus agrees to submit a listing of all campuses covered under this agreement as an addendum to this
agreement. The listing must include the name, address, and facility code of each campus. The IHL further certifies
that all campuses covered under this agreement are subject to the authority of the authorizing official signing the
agreement, and each campus has a certifying official or other employee who meets the requirements of section
21.4266(f)(3)(ii) of title 38, Code of Federal Regulations, and has access to the terms of this agreement.
9. This agreement is entered into under the authority of section 3317 of title 38, United States Code (as added by
section 5003 of Public Law 110-252, effective August 1, 2009) and section 21.9700 of title 38, Code of Federal
Regulations. The terms of this agreement will be effective for the entire academic year beginning on the first day
of August following the date of acceptance by a duly authorized officer of VA
.
10. The terms of this agreement will be available for public viewing on VA’s GI Bill website at www.GIBILL.va.gov .

11. Completed agreements (with the original signature of an official legally authorized to bind the IHL to this
agreement) must be received by VA no later than February 15 of each calendar year for the following academic
year. Late agreements may not be accepted.

RESPONDENT BURDEN: We need this information to determine your institution of higher learning’s eligibility to participate in the Yellow Ribbon Program.
Title 38 United States Code allows us to request this information. We estimate that you will need an average of 10 minutes to review the instructions, find
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
www.whitehouse.gov/omb/library/OMBINV.VA.EPA.html#VA. You may also call 1-888-GIBILL-1 (1-888-442-4551) to get information on where to send
comments or suggestions about this information collection. Your obligation to respond is voluntary.

AGREED TO:
SIGNATURE OF AUTHORIZING OFFICIAL

TITLE OF AUTHORIZING OFFICIAL

TELEPHONE NUMBER

FOR VA USE ONLY
ACCEPTED BY:
SIGNATURE OF VA OFFICIAL

DATE SIGNED

DATE ENTERED IN WEAMS

DATE SIGNED