Form VA Form 28-8832 VA Form 28-8832 Personalized Career Planning and Guidance

OMB Approved No. 2900-0265
Respondent Burden: 15 minutes
Expiration Date: XX/XX/XXXX

VA DATE STAMP
(For VA Use Only)

PERSONALIZED CAREER PLANNING AND GUIDANCE
INSTRUCTIONS: Before completing this form, read the Privacy Act and Respondent Burden information on
page 3. Use this form to apply for Personalized Career Planning and Guidance (PCPG) benefits under title 38
United State Code (U.S.C.) Chapter 36. For more information, contact us at https://iris.custhelp.va.gov, or
call us toll-free at 1-800-827-1000. If you use a Telecommunications Device for the Deaf (TDD), The Federal
relay number is 711. VA forms are available at www.va.gov/vaforms. After completing the form, if returning
the form by mail send to: Veteran Readiness and Employment (VR&E) Intake Center, Department of Veterans
Affairs, P.O. Box 5210, Janesville, WI 53547-5210.
SECTION I - CLAIMANT'S INFORMATION

NOTE: You may either complete the form online or by hand. If completed by hand, print the information requested in ink, neatly, and legibly to expedite processing of the form.
1. NAME OF CLAIMANT (First-Middle-Last)

4. VA FILE NUMBER (If applicable)

3. DATE OF BIRTH

2. SOCIAL SECURITY NUMBER OF CLAIMANT

5. CLAIMANT'S MAILING ADDRESS (Number and street or rural route, city or P.O., State and ZIP Code and Country)
No. &
Street
Apt./Unit Number

City

State/Province

ZIP Code/Postal Code

Country

I agree to receive electronic correspondence from
VA in regards to my claim.

7. E-MAIL ADDRESS

6.TELEPHONE NUMBER (Include Area Code)

Enter International Phone Number (If applicable)
9. RELATIONSHIP OF CLAIMANT TO VETERAN

8. GENDER OF CLAIMANT
MALE
FEMALE
10. ARE YOU A CHILD, 14 YEARS OR OLDER,
SPOUSE, OR SURVIVING SPOUSE WITH A
DISABILITY SEEKING SPECIAL RESTORATIVE
TRAINING?
YES

NO

SELF

CHILD

STEPCHILD

ADOPTED CHILD

SPOUSE

11. ARE YOU A CHILD, SPOUSE, OR
SURVIVING SPOUSE WITH A DISABILITY
SEEKING SPECIAL VOCATIONAL TRAINING?
YES

NO

SURVIVING SPOUSE
12. HAVE YOU RECEIVED AN INFORMATION PAMPHLET
EXPLAINING SURVIVORS' AND DEPENDENTS'
EDUCATIONAL ASSISTANCE BENEFITS?
YES

NO

SECTION II - INFORMATION CONCERNING DISABLED OR DECEASED VETERAN OR INDIVIDUAL ON ACTIVE DUTY
13. NAME OF VETERAN OR INDIVIDUAL ON ACTIVE DUTY ON WHOSE ACCOUNT BENEFITS ARE CLAIMED (First- Middle Initial -Last)

14. SOCIAL SECURITY NUMBER

15. DATE OF BIRTH (MM-DD-YYYY)

16. VA FILE NUMBER (If applicable)

17. BRANCH OF SERVICE

18. SERVICE NUMBER

19. DATE OF DEATH OR DATE LISTED
AS MISSING IN ACTION OR P.O.W. (MM-DD-YYYY)

SECTION III - SPECIAL INFORMATION CONCERNING CLAIMANT
20. IF YOU ARE THE SPOUSE OF A DISABLED VETERAN, IS A DIVORCE OR ANNULMENT PENDING?
YES

NO

21. IF YOU ARE THE SURVIVING SPOUSE OF A DECEASED VETERAN, HAVE YOU
REMARRIED SINCE HIS OR HER DEATH ?
YES
VA FORM
XXX XXXX

22. SURVIVING SPOUSE'S AGE AT TIME OF REMARRIAGE

NO

28-8832

SUPERSEDES VA FORM 28-8832, NOV 2015,
WHICH WILL NOT BE USED.

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VETERAN'S SSN
23. HAVE YOU EVER APPLIED FOR ANY OF THE FOLLOWING VA BENEFITS? (Check all that apply)
A.

VETERAN READINESS AND EMPLOYMENT (Chapter 31)

B.

VETERANS' EDUCATION ASSISTANCE BASED ON YOUR OWN SERVICE (Specify benefit)

C.

SURVIVORS' AND DEPENDENTS EDUCATIONAL ASSISTANCE (Chapter 35)

If Item 23C is checked, please specify the following:

NAME OF VETERAN ON WHOSE ACCOUNT YOU PREVIOUSLY CLAIMED BENEFITS

VA FILE NUMBER OR SOCIAL SECURITY NUMBER

D.

OTHER (Specify)

E.

NONE

SECTION IV - CLAIMANT'S MILITARY SERVICE
24. HAVE YOU EVER SERVED ON ACTIVE DUTY IN THE ARMED FORCES? (Including an initial period of active duty for training for a period of 3 months or more
OR subsequent periods of active duty for training of 6 months or more) (If "NO," skip this part and continue to Section V.)
YES

NO

25. SERVICE INFORMATION
(Enter the following information for each period of active duty. Attach a copy of your DD214.
If you have already sent VA a DD214, do not send one with this application.) (If additional space is needed use Item 26, Remarks.)
25A. DATE ENTERED
ACTIVE DUTY
25C. BRANCH OF SERVICE
OR RESERVE
OR GUARD COMPONENT

Month

Year

Day

ARMY

NAVY

COAST GUARD

25B. DATE SEPARATED
FROM ACTIVE DUTY

MARINE CORPS

AIR FORCE

Month

Day

Year

SPACE FORCE

OTHER (Specify)

25D. CHARACTER OF
DISCHARGE
25A. DATE ENTERED
ACTIVE DUTY
25C. BRANCH OF SERVICE
OR RESERVE
OR GUARD COMPONENT

Year

Day

Month

ARMY

NAVY

25B. DATE SEPARATED
FROM ACTIVE DUTY

MARINE CORPS

AIR FORCE

Month

Day

Year

SPACE FORCE

OTHER (Specify)

COAST GUARD

25D. CHARACTER OF
DISCHARGE
25A. DATE ENTERED
ACTIVE DUTY
25C. BRANCH OF SERVICE
OR RESERVE
OR GUARD COMPONENT

Month

Year

Day

NAVY

ARMY
COAST GUARD

25B. DATE SEPARATED
FROM ACTIVE DUTY

MARINE CORPS

AIR FORCE

Month

Day

Year

SPACE FORCE

OTHER (Specify)

25D. CHARACTER OF
DISCHARGE
25A. DATE ENTERED
ACTIVE DUTY

25C. BRANCH OF SERVICE
OR RESERVE
OR GUARD COMPONENT

Month

Year

Day

ARMY
COAST GUARD

NAVY

25B. DATE SEPARATED
FROM ACTIVE DUTY

MARINE CORPS

AIR FORCE

Month

Day

Year

SPACE FORCE

OTHER (Specify)

25D. CHARACTER OF
DISCHARGE
VA FORM 28-8832, XXX XXXX

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VETERAN'S SSN
26. REMARKS (Use this space to provide information that does not fit elsewhere on this form or that will help VA process your claim. Refer to the item numbers on this
form to help us match your answers to the correct questions. If more space is needed, please attach separate sheets of paper. Be sure to place your name and Social
Security Number on each additional page.)

SECTION V - CERTIFICATION AND SIGNATURE OF CLAIMANT

(All Claimant's Must Complete This Part)

I CERTIFY THAT all statements in my application are true and correct to the best of my knowledge and belief.
27B. DATE SIGNED (MM-DD-YYYY)

27A. SIGNATURE OF CLAIMANT

PENALTY: The law provides severe penalties (including fine and/or imprisonment) for willfully submitting any statement or evidence of a material
fact you know to be false, or for fraudulent receipt of any document you are not entitled to.

SECTION VI - SIGNATURE OF PARENT, GUARDIAN, OR CUSTODIAN

(This section must be completed if you are a minor child)

28. NAME OF PARENT, GUARDIAN, OR CUSTODIAN (Type or print)

29B. DATE SIGNED (MM-DD-YYYY)

29A. SIGNATURE OF (Check one)
PARENT

GUARDIAN

CUSTODIAN

30. TELEPHONE NUMBER OF PARENT, GUARDIAN, OR CUSTODIAN (Include Area Code).

31. DATE REFERRED TO VR & E (MM-DD-YYYY)

PRIVACY ACT NOTICE: The responses you submit are considered confidential (38 U.S.C. 5701). Your obligation to respond is required in order to obtain benefits.
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 (i.e., civil or criminal law enforcement, congressional communications, epidemiological or research studies, the collection of money
owed to the United States, litigation in which the United States is a party or has an interest, the administration of VA programs and delivery of VA benefits, verification of
identity and status, and personnel administration) as identified in the VA system of records, 58VA21/22/28, Compensation, Pension, Education, and Vocational
Rehabilitation and Employment Records - VA, published in the Federal Register. Information that you furnish may be utilized in computer matching programs with other
Federal or State agencies for the purpose of determining your eligibility to receive VA benefits, as well as to collect any amount owed to the United States by virtue of
your participation in any benefit program administered by the Department of Veterans Affairs. You are required to provide your Social Security number requested under
38 U.S.C. 5101(c)(1). VA may disclose Social Security numbers as authorized under the Privacy Act and specifically may disclose them for purposes stated above.
RESPONDENT BURDEN: This form is used to apply for Personalized Career Planning and Guidance benefits under title 38 U.S.C. Chapter 36. Title 38, United States
Code, allows VA 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 this
form. VA cannot conduct or sponsor a collection of information unless a valid Office of Management and Budget (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.reginfo.
gov/public/do/PRAMain. If desired, you can call 1-800-827-1000 to get information on where to send comments or suggestions about this form.
VA FORM 28-8832, XXX XXXX

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PERSONALIZED CAREER PLANNING AND GUIDANCE (PCPG) APPLICATION
Information and Instructions for Completing this Application
(Please keep these instructions for future reference)
NOTE: VA form 28-8832 is available on the Internet at www.va.gov/vaforms.
PCPG BENEFITS ARE AVAILABLE FREE OF CHARGE if you meet one of the following conditions:
1.You are a Veteran or dependent eligible for educational benefits under a program that VA administers;
2.You were discharged or released from active duty under conditions other than dishonorable not more
than 1 year ago;
3.You are on active duty and 6 months or less remain before your scheduled release or discharge from service.
You may receive guidance about any matter, including personal problems, related to:
• Guidance to facilitate career/occupational decisions for civilian or military occupations
• Adjustment counseling to address personal problems that may interfere with achieving any educational
or employment goal
• Educational/Vocational guidance to help you develop a training, educational or employment plan
• Explanation of test results, exploration of potential objectives and assistance in developing
a successful program
What is discussed depends on you, your situation and needs. You can learn more about yourself; career opportunities
and requirements; training possibilities; sources of financial aid; and how to carry through on plans that you make.
HOW TO GET PCPG BENEFITS
Complete this application and mail it to: Veteran Readiness and Employment (VR&E) Intake Center, Department of
Veterans Affairs, P.O. Box 5210, Janesville, WI, 53547-5210. If you have received a DD214, you should attach a copy
of it, unless you are still on active duty or if you are applying as a dependent of a Veteran. VA will arrange for a counselor
to meet with you. There is no charge for PCPG benefits, but you will have to pay your own travel.
APPLICATION INSTRUCTIONS
Please complete only those areas which are applicable to you. The number on the instructions matches the item
numbers on the application. Items not mentioned are self-explanatory. If you have a question, please contact VA at
1-800-827-1000 and request help.
Item 4. VA may have assigned the claimant an eight-digit file number. If you know the number, write it in the space
provided.
Item 9. "Child" includes adopted children and stepchildren who are members of the Veteran's or individual's household.
Married children are eligible.
Item 23C. If you have previously applied for benefits as the dependent child or spouse of a Veteran who is permanently
and totally disabled due to service-connected disabilities or who died on active duty, write the name of the person
(parent or spouse) under whom you received these benefits and the file number or social security number.
Item 23E. Check this box if you have never applied for VA educational benefits.
IMPORTANT: This form is an application for PCPG benefits only. Do not use this form to apply for VETERAN
READINESS AND EMPLOYMENT BENEFITS (Chapter 31) (use the VA form 28-1900, Disabled Veterans Application
For Vocational Rehabilitation) or for VETERAN'S EDUCATION ASSISTANCE (Chapter 30, 32, 33, 1606 or 1607) (use
the VA Form 22-1990, Application For VA Education Benefits). These forms are available on the Internet at www.va.gov/
vaforms.
VA FORM 28-8832, XXX XXXX

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