22-5490 Dependents' Application for VA Education Benefits

OMB Approved No. 2900-0098
Respondent Burden: 45 minutes
Expiration Date: XXXXXXX

DEPENDENTS' APPLICATION FOR VA EDUCATION BENEFITS
(Under Provisions of chapters 33 and 35, of title 38, U.S.C.)
INTERNET VERSION AVAILABLE - You may complete and submit your application online at: www.va.gov.

PART I - APPLICANT INFORMATION
2. SEX OF APPLICANT

1. SOCIAL SECURITY NUMBER

MALE

3. DATE OF BIRTH

FEMALE

4. NAME (First name, middle initial, last name)

5. CURRENT MAILING ADDRESS (Number and street or rural route, city or P.O., State and ZIP Code)

6. TELEPHONE NUMBER(S) (Including Area Code)
HOME

MOBILE

7. EMAIL ADDRESS (If applicable)

8. DIRECT DEPOSIT (Attach a voided personal check or deposit slip and provide the information below. See Instructions for additional information.)
ROUTING OR TRANSIT NUMBER

ACCOUNT NUMBER

ACCOUNT TYPE

(Routing number must be 9 digits)

SAVINGS

CHECKING

9. PLEASE PROVIDE THE NAME, ADDRESS, AND TELEPHONE NUMBER OF SOMEONE WHO WILL ALWAYS KNOW WHERE YOU CAN BE REACHED
C. TELEPHONE NUMBER (Include Area Code)

B. ADDRESS

A. NAME

PART II - QUALIFYING INDIVIDUAL INFORMATION (See instructions for #14)
10. NAME OF QUALIFYING INDIVIDUAL (PARENT OR SPOUSE) ON WHOSE ACCOUNT BENEFITS ARE BEING CLAIMED (First name, middle initial, last name)

11. SOCIAL SECURITY NUMBER OR VA FILE NUMBER

13. DATE OF BIRTH

12. BRANCH OF SERVICE

14A. DID PARENT OR SPOUSE DIE WHILE SERVING ON ACTIVE DUTY OR WHILE ON DUTY OTHER THAN ACTIVE
DUTY AS A MEMBER OF THE ARMED FORCES?
(If "Yes," is checked complete (If "No," is checked then you do not qualify
YES
NO
Item 14D)
for the Fry Scholarship)

14B. DATE LISTED AS MISSING IN ACTION
OR P.O.W. (If applicable)

14D. DATE OF DEATH
14C. DID PARENT OR SPOUSE DIE FROM A SERVICE CONNECTED DISABILITY WHILE A MEMBER OF THE
SELECTED RESERVE?
(If "Yes," is checked complete (If "No," is checked then you do not qualify
YES
NO
Item 14D)
for the Fry Scholarship)
15. IS QUALIFYING INDIVIDUAL (PARENT OR SPOUSE) ON ACTIVE DUTY? 16. DO YOU (APPLICANT) OR THE QUALIFYING INDIVIDUAL (PARENT OR SPOUSE)
HAVE AN OUTSTANDING FELONY AND/OR WARRANT?
YES
NO
YES
NO

PART III - RELATIONSHIP AND BENEFIT INFORMATION
17. YOUR RELATIONSHIP TO QUALIFYING INDIVIDUAL (Check only one)
SPOUSE/SURVIVING SPOUSE

CHILD/STEPCHILD/ADOPTED CHILD

(Please complete only Section I on page 2, and then proceed to Part IV)

(Please complete only Section II on page 2, and then proceed to Part IV)

SECTION I - SPOUSE/SURVIVING SPOUSE
18. IS A DIVORCE OR ANNULMENT PENDING TO THE
QUALIFYING INDIVIDUAL?
YES
VA FORM
XXXX

NO

22-5490

19. IF YOU ARE THE SURVIVING SPOUSE, HAVE YOU REMARRIED?
YES

NO

(If "Yes," please provide date of remarriage)

SUPERSEDES VA FORM 22-5490, JUL 2021,
WHICH WILL NOT BE USED.

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SOCIAL SECURITY NUMBER OF APPLICANT

SECTION I - SPOUSE/SURVIVING SPOUSE (Continued)
20. SPOUSE/SURVIVING SPOUSE SELECT THE BENEFIT THAT YOU ARE APPLYING FOR BELOW:
PLEASE CAREFULLY READ THE INFORMATION AND INSTRUCTIONS ON PAGE 6, ITEM 20 BEFORE SELECTING BOX "A"
OR "B" BELOW REGARDING THE BENEFIT FOR WHICH YOU ARE APPLYING. THE INFORMATION AND INSTRUCTIONS ON
PAGE 6 PROVIDE LINKS TO VA WEBSITES WHERE YOU WILL BE ABLE TO COMPARE "DEA" AND "FRY SCHOLARSHIP"
BENEFITS. YOU WILL ALSO FIND OTHER ELIGIBILITY RELATED INFORMATION THERE.

IMPORTANT ►
A.

AS A SPOUSE OR SURVIVING SPOUSE BASED ON 100%
PERMANENT AND TOTAL DISABILITY, SERVICE CONNECTED
OR LINE OF DUTY DEATH, I AM APPLYING FOR
CHAPTER 35 - DEA BENEFITS.

NOTE - BY CHECKING THIS BOX I ACKNOWLEDGE THAT I UNDERSTAND
THIS ELECTION IS IRREVOCABLE AND MAY NOT BE CHANGED.

AS A SURVIVING SPOUSE BASED ON EITHER "IN THE LINE

B. OF DUTY" DEATH WHILE ON ACTIVE DUTY OR DUTY OTHER

THAN ACTIVE DUTY WHILE A MEMBER OF THE ARMED FORCES,
OR A SERVICE CONNECTED DEATH WHILE SERVING AS A
MEMBER OF THE SELECTED RESERVE AFTER SEPTEMBER 10, 2001.
I AM APPLYING FOR CHAPTER 33 FRY SCHOLARSHIP BENEFITS.

NOTE - BY CHECKING THIS BOX I ACKNOWLEDGE THAT I UNDERSTAND
THIS ELECTION IS IRREVOCABLE AND MAY NOT BE CHANGED.

SECTION II - CHILD/STEPCHILD/ADOPTED CHILD
21. CHILD/STEPCHILD/ADOPTED CHILD SELECT THE BENEFIT THAT YOU ARE APPLYING FOR BELOW:
PLEASE CAREFULLY READ THE INFORMATION AND INSTRUCTIONS ON PAGE 6, ITEM 21 BEFORE SELECTING BOX "A"
OR "B" BELOW REGARDING THE BENEFIT FOR WHICH YOU ARE APPLYING. THE INFORMATION AND INSTRUCTIONS ON
PAGE 5 PROVIDE LINKS TO VA WEBSITES WHERE YOU WILL BE ABLE TO COMPARE "DEA" AND "FRY" BENEFITS. YOU
WILL ALSO FIND OTHER ELIGIBILITY RELATED INFORMATION THERE.

IMPORTANT ►
A.

I AM APPLYING FOR CHAPTER 35 - DEA BENEFITS.

B.

I AM APPLYING FOR CHAPTER 33 - FRY SCHOLARSHIP
BENEFITS.

NOTE - BY CHECKING THIS BOX I ACKNOWLEDGE THAT I UNDERSTAND
THIS ELECTION IS IRREVOCABLE AND MAY NOT BE CHANGED.

NOTE - BY CHECKING THIS BOX I ACKNOWLEDGE THAT I UNDERSTAND
THIS ELECTION IS IRREVOCABLE AND MAY NOT BE CHANGED.

Important - If your parent died in the line of duty prior to August 1, 2011, you
may apply for both DEA and Fry Scholarship benefits.
If you are eligible for both Chapter 35 (DEA) and Chapter 33 (Fry Scholarship) benefits
and you would like to use the Chapter 35 benefit first, check the box below.

Important - If your parent died in the line of duty prior to August 1, 2011, you
may apply for both DEA and Fry Scholarship benefits.
If you are eligible for both Chapter 35 (DEA) and Chapter 33 (Fry Scholarship)
benefits and you would like to use the Chapter 33 benefit first, check the box below.

CHAPTER 33 - FRY SCHOLARSHIP

CHAPTER 35 - DEA

IMPORTANT: If you are over the age of 18 once you receive either the DEA or FRY SCHOLARSHIP benefits, you will no longer receive payments of Dependency
and Indemnity Compensation (DIC) or Pension and you may no longer be claimed as a dependent in a Compensation claim. If you are under the age of 18, on your 18th
birthday you will lose eligibility for DIC or Pension payments and you will no longer be claimed as a dependent in a Compensation claim.
CAREFULLY READ THE INFORMATION AND INSTRUCTIONS ON PAGE 6, ITEM 22 BEFORE COMPLETING THE ELECTION BOX BELOW.
YOU ARE STRONGLY ENCOURAGED TO DISCUSS YOUR ELECTION WITH A VA COUNSELOR.
22. I CERTIFY THAT I UNDERSTAND THE EFFECTS THAT THIS ELECTION TO RECEIVE DEA OR FRY SCHOLARSHIP BENEFITS WILL HAVE ON MY ELIGIBILITY
TO RECEIVE DIC OR PENSION BENEFITS (Please read Information and Instructions Page 6 for additional information)
YES

NO

PART IV - BENEFIT AND TYPE OF EDUCATION OR TRAINING INFORMATION
23A. DATE YOU WILL BEGIN SCHOOL OR TRAINING (MM/DD/YYYY) (If known, otherwise, you may skip 23A)
23B. TYPE OF EDUCATION OR TRAINING (Check ONE box)
COLLEGE OR OTHER SCHOOL
FARM COOPERATIVE - (DEA ONLY)
LICENSING OR CERTIFICATION TEST
APPROVED PREP COURSES FOR LICENSE/CERTIFICATION TEST (Chapter 33 and Chapter 35 - Effective 8/1/2021)
APPRENTICESHIP OR ON-THE-JOB TRAINING
NATIONAL ADMISSION EXAMS OR NATIONAL EXAMS FOR CREDIT
CORRESPONDENCE COURSE (Fry Scholarship and DEA - Spouses only)
FLIGHT TRAINING (Fry Scholarship only)
24. NAME AND ADDRESS OF SCHOOL OR TRAINING FACILITY (Number and Street, City or P.O., State and ZIP Code)

25. SPECIFY YOUR EDUCATION OR CAREER OBJECTIVE, IF KNOWN (e.g., Bachelor of Arts in Accounting, Welding Certificate, Police Officer)

VA FORM 22-5490, XXXX

PAGE 2

SOCIAL SECURITY NUMBER OF APPLICANT
26. WOULD YOU LIKE TO RECEIVE VOCATIONAL AND EDUCATIONAL COUNSELING? (See Information and Instructions, Item 26 for more information regarding

vocational and educational counseling)
NO

YES

27A. [ DEA ONLY] DO YOU HAVE A MENTAL OR PHYSICAL DISABILITY FOR

WHICH YOU ARE SEEKING SPECIAL RESTORATIVE TRAINING?
(See Information and Instructions, Page 6, for details regarding restorative training)

27B. [ DEA ONLY] DO YOU HAVE A MENTAL OR PHYSICAL

DISABILITY FOR WHICH YOU ARE SEEKING SPECIAL
VOCATIONAL TRAINING? (See Information and Instructions,
Page 6, for details regarding special vocational training)

YES

YES

NO

NO

PART V - APPLICATION HISTORY
28. PRIOR TO THIS APPLICATION, HAVE YOU EVER APPLIED FOR OR RECEIVED ANY OF THE FOLLOWING VA BENEFITS? (Check all appropriate boxes)
A.

DISABILITY COMPENSATION OR PENSION

B.

DEPENDENTS' INDEMNITY COMPENSATION (DIC)

C.

VETERAN READINESS AND EMPLOYMENT BENEFITS (Chapter 31)

D.

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

E.

VETERANS EDUCATION ASSISTANCE BASED ON SOMEONE ELSE'S SERVICE
SPECIFY BENEFIT(S) BY CHECKING APPLICABLE BOX BELOW AND COMPLETE ITEMS 29 AND 30
TRANSFERRED ENTITLEMENT
CHAPTER 35 - SURVIVORS' AND DEPENDENTS' EDUCATIONAL ASSISTANCE PROGRAM (DEA)
CHAPTER 33 - POST-9/11 GI BILL MARINE GUNNERY SERGEANT DAVID FRY SCHOLARSHIP

F.

NONE

G.

OTHER (Specify benefit(s):

IMPORTANT: Complete Items 29 and 30 only if you checked the box for Item 28E above.

29. NAME OF INDIVIDUAL ON WHOSE ACCOUNT YOU PREVIOUSLY CLAIMED BENEFITS (First, Middle, Last)
30. SOCIAL SECURITY NUMBER OF INDIVIDUAL ON WHOSE ACCOUNT YOU PREVIOUSLY CLAIMED BENEFITS

PART VI - APPLICANT'S MILITARY SERVICE INFORMATION
(NOTE: Chapter 35 benefits are not payable while an eligible person is on active duty)
31. HAVE YOU EVER SERVED ON ACTIVE DUTY IN THE ARMED FORCES? (If "No," skip to Part VII)
YES

NO

32. INFORMATION ABOUT YOUR PERIOD(S) OF ACTIVE DUTY (If you need additional space use Item 38, Remarks)
A. DATE ENTERED ACTIVE DUTY

B. DATE SEPARATED
FROM ACTIVE DUTY

C. BRANCH OF SERVICE OR
RESERVE OR GUARD COMPONENT

D. CHARACTER OF DISCHARGE

PART VII - EDUCATION, TRAINING AND EMPLOYMENT
SECTION I - EDUCATION & TRAINING
33. CHECK THE APPROPRIATE BOX AND ENTER THE DATE IN ITEM 34
GRADUATED FROM HIGH SCHOOL

DISCONTINUED HIGH SCHOOL

EXPECT TO GRADUATE FROM HIGH SCHOOL

AWARDED GED

35A. TYPE
OF SCHOOL

35B. NAME AND LOCATION
OF SCHOOL
(City and State)

35C. DATES OF TRAINING
FROM

TO

NEVER ATTENDED
HIGH SCHOOL

34. DATE

35E. DEGREE, DIPLOMA
35D. NUMBER OF
SEMESTER, QUARTER, OR
OR CERTIFICATE
CLOCK HOURS COMPLETED
RECEIVED

35F. MAJOR FIELD OR
COURSE OF STUDY

HIGH SCHOOL
COLLEGE
VOCATIONAL
OR TRADE
OTHER

(Specify)

VA FORM 22-5490, XXXX

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SOCIAL SECURITY NUMBER OF APPLICANT

PART VII - EDUCATION, TRAINING AND EMPLOYMENT (Continued)
SECTION II - EMPLOYMENT
36. CURRENT AND PAST EMPLOYMENT
A. EMPLOYER

B. JOB TITLE

C. NUMBER OF MONTHS
EMPLOYED

D. LICENSE OR RATING

NOTE: Complete Items 37A and 37B only if you are a civilian employee of the U.S. Government.
37A. DO YOU EXPECT TO RECEIVE FUNDS FROM YOUR AGENCY OR
DEPARTMENT FOR THE SAME COURSES FOR WHICH YOU EXPECT TO
RECEIVE VA EDUCATIONAL ASSISTANCE? (If "Yes," complete Item 37B)
YES

37B. SOURCE OF EDUCATIONAL ASSISTANCE FROM GOVERNMENT
EMPLOYMENT

NO

PART VIII - REMARKS AND REMINDERS AND VA EDUCATION BENEFITS PAMPHLET
SECTION I - REMARKS
38. REMARKS (If more space is needed, please attach a separate sheet of paper. Be sure to include name and social security number on each sheet)

SECTION II - REMINDERS
DID YOU REMEMBER TO:
• WRITE YOUR SOCIAL SECURITY NUMBER ON THE TOP OF EACH PAGE
• PROVIDE YOUR COMPLETE MAILING AND EMAIL ADDRESS
• ATTACH SUPPORTING DOCUMENTS (e.g., birth certificate, marriage license, DD214, etc.)
SECTION III - VA EDUCATION BENEFITS INFORMATION
39. THE MOST CURRENT INFORMATION ON VA EDUCATION BENEFITS IS AVAILABLE ONLINE AT www.va.gov.

PART IX - CERTIFICATION AND SIGNATURE OF APPLICANT
I CERTIFY THAT all statements in my application are true and correct to the best of my knowledge and belief.
40A. SIGNATURE OF APPLICANT (DO NOT PRINT) (You must be at least 18 years of age to legally sign this form.
If under 18, your parent, guardian or custodian must complete and sign in Part X).

40B. DATE SIGNED

SIGN HERE ►

PENALTY: Willfully false statements as to a material fact in a claim for education benefits is a punishable offense and may result in the forfeiture of these or other
benefits and in criminal penalties.

PART X - SIGNATURE OF PARENT, GUARDIAN OR CUSTODIAN
(This section must be completed by the parent, guardian, or custodian if the applicant is a minor)
41. NAME OF PARENT, GUARDIAN, OR CUSTODIAN (First, Middle Initial, Last) (Type or print)

42A. MAILING ADDRESS OF PARENT, GUARDIAN, OR CUSTODIAN
Number and Street

Apt./Unit Number

City, State, ZIP Code

42B. TELEPHONE NUMBER(S) OF PARENT, GUARDIAN, OR CUSTODIAN (Include Area Code)
MOBILE:

HOME:

42C. EMAIL ADDRESS OF PARENT, GUARDIAN, OR CUSTODIAN (If applicable)

43A. SIGNATURE OF:
PARENT/GUARDIAN/CUSTODIAN (check if under age 18)
VA FORM 22-5490, XXXX

43B. DATE SIGNED
SIGN HERE ►
(DO NOT PRINT)

PAGE 4

(Please retain these Information and Instructions Pages for future reference)
INFORMATION AND INSTRUCTIONS FOR COMPLETING THE
DEPENDENTS' APPLICATION FOR VA EDUCATION BENEFITS
(VA FORM 22-5490)
Do not use this form to apply for Veterans' education assistance based on your own service (chapters 30, 32, 33, or 1606)
or Veterans Readiness and Employment benefits (chapter 31). To apply for Veterans' education assistance based on your
own service, use VA Form 22-1990. To apply for Veteran Readiness and Employment benefits, use VA Form 28-1900. VA
forms are available at www.va.gov/vaforms.
NOTE: The numbers on these pages match the item numbers on this application. Items not mentioned are self-explanatory.
ITEM 8. The Department of the Treasury requires all Federal benefit payments be made by electronic funds transfer (EFT), also called direct deposit. To enroll in
direct deposit, please attach a voided personal check or deposit slip, and provide the information requested in Item 8. If you do not have a bank account, please
visit https://www.benefits.va.gov/benefits/banking.asp. This website provides information about the Veterans Benefits Banking Program (VBBP), and a link to
banks and credit unions that may fit your needs. You may also call 1-800-827-1000. If you elect not to enroll, you must contact representatives handling waiver
requests for the Department of the Treasury at 1-888-224-2950. They will encourage your participation in EFT and address any questions or concerns you may
have.
ITEM 14A. Please check Yes or No for this box if you are a child or spouse of an active duty service member or a member of the Selected Reserve and the
member died in the line of duty while serving. Note: Determination of 'died in the line of duty while serving on duty other than active duty' will be determined by the
Department of Defense and the VA.
ITEM 14C. Please check Yes or No for this box if you are a child or spouse of a member of the Selected Reserve and the member died after September 10, 2001
from a service connected disability as determined by VA.
ITEM 16. You will not be eligible to receive benefits for any period for which you or the qualifying individual on whose account you are claiming benefits has an
outstanding felony warrant. Any benefits paid to you for such period will result in an overpayment and be subject to collection.
ITEM 17. If you are certifying that you are married for the purpose of VA benefits, your marriage must be recognized by the place where you and/or your
spouse resided at the time of marriage or where you and/or your spouse resided when you filed your claim (or a later date when you became eligible for
benefits) (38 U.S.C.§ 103(3)). Additional guidance on when VA recognizes marriages is available at http://www.va.gov/opa/marriage/.
ITEM 20. IMPORTANT - PLEASE READ THE INFORMATION BELOW BEFORE MAKING YOUR SELECTION IN ITEM 20A OR 20B REGARDING
THE BENEFIT FOR WHICH YOU ARE APPLYING.
• To qualify for the Post-9/11 GI Bill Marine Gunnery Sergeant John David Fry Scholarship, you must be the surviving spouse of a member
who died in the line of duty while serving on active duty or while serving on duty other than active duty while a member of the Selected Reserve
or from a service connected disability while a member of the Selected Reserve. The death must have occurred after September 10, 2001.
• To qualify for Survivor's and Dependents' Educational Assistance (DEA) you must be either:
(1) The spouse of a veteran who is permanently and totally disabled as a result of a service-connected disability, OR
(2) The spouse of an individual on active duty who has been listed as missing in action, captured in the line of duty by
hostile force, forcibly detained or interned in the line of duty by hostile force, or forcibly detained or interned in the line of duty by
a foreign government or power for more than 90 days, OR
(3) The surviving spouse or child of a veteran who died of a service-connected disability or who dies while a service-connected disability
was rated permanent and total in nature, OR
(4) The surviving spouse of an individual on active duty for which the evidence shows that the individual is hospitalized for receiving
outpatient medical care services or treatment; has a total disability permanent in nature incurred or aggravated in the line of duty
in the active military, naval, or air service; and the service member is likely to be discharged or released from such service
for such disability.
NOTE: If you are eligible for both Chapter 35 DEA and Chapter 33 Post-9/11 GI Bill Marine Gunnery Sergeant John David Fry Scholarship
(Fry Scholarship) benefits, you must relinquish/give up entitlement to one or the other benefit for which you are eligible, even if entitlement
arises from separate events. In other words, you must forfeit eligibility to the other benefit even if your eligibility is due to:
• A separate Period of Service (POS) other than the one for which the death of the spouse is associated; OR
• A separate POS other than the one for which your spouse has a total disability permanent in nature resulting
from a service-connected disability, death due to service connected disability; OR
• A separate POS based on any other criteria as listed in 38 U.S.C. § 3501(a)(1); OR
• Death of any other individual identified in Item 10 of this application.
IMPORTANT: You cannot retain eligibility for both programs simultaneously. Therefore, by checking either box "A" or box "B" in Item 20, you agree and
understand that you are making an irrevocable election to receive the selected benefit and your election may not be changed.
IMPORTANT: Eligibility for DEA will be terminated in the event that VA determines that the individual on whose account benefits are claimed is no
longer totally disabled or VA is notified that the individual is no longer listed as captured, missing in action, or forcibly detained.
Note: Before making your election selection, you can compare the differences between DEA and Fry, and the benefits each provide in order
to help you make the best choice that suits your needs. This benefit comparison information can be found on the VA website at:
https://www.benefits.va.gov/gibill/docs/factsheets/fry_scholarship.pdf. You can also find additional information about each program by visiting the
GI Bill website at: https://benefits.va.gov/gibill/ and using the comparison tool.

VA FORM 22-5490, XXXX

PAGE 5

INFORMATION AND INSTRUCTIONS (Continued)

ITEM 21. IMPORTANT - PLEASE READ THE INFORMATION BELOW BEFORE MAKING YOUR SELECTION IN ITEM 21A OR 21B REGARDING THE
BENEFIT FOR WHICH YOU ARE APPLYING.
• To qualify for the Post-9/11 GI Bill Marine Gunnery Sergeant John David Fry Scholarship, you must be the dependent child of a member who
died in the line of duty while serving on active duty or while serving on duty other than active duty while a member of the Selected Reserve or died
from a service connected disability while a member of the Selected Reserve. The death must have occurred after September 10, 2001.
• To qualify for Survivor's and Dependents' Educational Assistance (DEA) you must be either:
(1) The child of a veteran who is permanently and totally disabled as a result of a service-connected disability; OR
(2) The child of an individual on active duty who has been listed as missing in action, captured in the line of duty by hostile force,
forcibly detained or interned in the line of duty by hostile force, or forcibly detained or interned in the line of duty by a foreign
government or power for more than 90 days, OR
(3) The child of a veteran who died of a service-connected disability or who dies while a service-connected disability was rated
permanent and total in nature, OR
(4) The child of an individual on active duty for which the evidence shows that the individual is hospitalized for receiving outpatient
medical care services or treatment; has a total disability permanent in nature incurred or aggravated in the line of duty in the active
military, naval, or air service; and the service member is likely to be discharged or released from such service for such disability.
NOTE: Children of a member of the Selected Reserve who died while on duty other than active duty DO NOT qualify for DEA. Therefore,
you can only apply for the Fry Scholarship.
PARENT'S DEATH PRIOR TO AUGUST 1, 2011 • The election you choose in Item 21 does not eliminate your eligibility for the alternate benefit (either DEA and the Chapter 33 Post-9/11 GI
Bill-Fry Scholarship based on the same event (i.e., your parent's line of duty death that occurred prior to August 1, 2011).
PARENT'S DEATH ON OR AFTER AUGUST 1, 2011 • The election you choose in Item 21 does eliminate your eligibility for the alternate education benefit (either DEA and the Chapter 33 Post-9/11
GI Bill-Fry Scholarship based on the same event (i.e., your parent's line of duty death that occurred on or after August 1, 2011). Therefore, you
must relinquish/give up eligibility entitlement to the benefit that you are not applying for but only with regard to the entitlement arising from
the same event (i.e., your parent's line of duty death that occurred on or after August 1, 2011). By checking either box "A" or box "B" in Item 21,
you agree and understand that you are making an irrevocable election to receive the selected benefit and your election may not be changed.
IMPORTANT: Unlike spouses, children may be able to retain eligibility for both programs simultaneously if they qualify under different events and
individuals (i.e., a separate parent's line of duty death that occurred on or after August 1, 2011).
IMPORTANT: Eligibility for (DEA) will be terminated in the event that VA determines that the individual on whose account benefits are claimed is no
longer totally disabled or VA is notified that the individual is no longer listed as captured, missing in action, or forcibly detained.
NOTE: Before making your election selection, you can compare the differences between DEA and Fry, and the benefits each provide in order to
help you make the best choice that suits your needs. This benefit comparison information can be found on the VA website at:
https://www.benefits.va.gov/gibill/docs/factsheets/fry_scholarship.pdf. You can also find additional information about each program by visiting the GI Bill
website at https://benefits.va.gov/gibill/, and using the comparison tool.
ITEM 22. Your election to receive Survivors' and Dependents' Education Assistance (DEA) or Chapter 33 Post-9/11 GI Bill Marine Gunnery Sergeant
John David Fry Scholarship (Fry Scholarship) in lieu of payments of compensation, pension, and Dependents' Indemnity Compensation (DIC) is final and cannot
be changed. This means that if you are 18 or older, payments of compensation, pension, and Dependents' Indemnity Compensation (DIC) will be terminated upon
issuance of a DEA or Fry Scholarship benefit payment. If you are under the age of 18, these benefits will be terminated on your
18th birthday. If you are planning to pursue a program of education for more than 36 months, you should consider deferring receipt of DEA or Fry
Scholarship benefits. We strongly recommend that you discuss your education or training plans with a VA counselor before making a decision.
ITEM 23B. Types of education or training programs are self-explanatory, except for the following:
"Licensing or Certification Test" - A "licensing test" is a test offered by a state, local, or federal agency that is required by law to practice an occupation. A
"certification test" is a test designed to provide affirmation of an individual's qualifications in a specific occupation.
"Prep Course for License/Certification Test" - A preparatory course prepares you to take a licensing or certification test as described above. Reimbursement
for this type of training begins for courses taken on or after August 1, 2021.
"National Admission Exams or National Exams for Credit" - You may be reimbursed for the cost of approved tests for admission to or credit at institutions of
higher learning.
"Correspondence Course" - You may receive benefits for correspondence training. Payments for correspondence courses are made quarterly after VA receives
a certification showing the number of lessons completed. DEA children are not eligible to receive benefits for this training. For more information on
correspondence courses, you can go to the VA website at: https://www.benefits.va.gov/gibill/correspondence_training.asp.
"Flight Training" - You must already have a private pilot's license. If you are taking an Airline Transport Pilot course, you must have a valid first-class
medical certificate on the date that you enter training. For all other flight courses, you must have a valid second-class medical certificate on the date that
you enter training.
ITEM 26 - VA VOCATIONAL AND EDUCATIONAL COUNSELING HELP AVAILABLE: VA offers a wide range of services to assist you in planning
your educational and/or career goals. Services include educational and vocational guidance and testing to develop a greater understanding of your skills, talents
and interests. For more information on VA counseling, call VA toll-free at 1-888-GIBILL-1 (1-888-442-4551) or if you use the Telecommunications Device for the
Deaf (TDD), the Federal Relay number is 711.
ITEM 27 - Any individual eligible under the DEA program may receive Special Restorative Training or Specialized Vocational Training if a VA counselor
determines that a specialized program is needed to overcome the effects of a physical or mental handicap. To be eligible for receipt of specialized training, the
disability must prevent you from pursuing an educational program. Examples of Special Restorative Training include speech and voice correction, language
retraining, lip reading, and Braille reading and writing. Specialized Vocational Training consists of specialized courses leading to a suitable vocational objective.

VA FORM 22-5490, XXXX

PAGE 6

HOW TO FILE YOUR CLAIM
You may complete and submit your application online at www.va.gov or be sure to do the following:
(A) If you have selected a school or training establishment:
Step 1: Mail the completed application to the VA Regional Processing Office for the region of that school's physical address.
See page 8 for addresses of the VA Regional Processing Offices.
Step 2: Tell the Veterans Certifying Official at your school or training establishment that you have applied for VA education
benefits. Ask him or her to submit your enrollment information using VA Form 22-1999, Enrollment Certification, or its electronic
version.
Step 3: Wait for VA to process your application and notify you of its decision concerning your eligibility for education benefits.
(B) If you have not selected a school or training establishment:
Step 1: Mail the completed application to the VA Regional Processing Office for the region of your home address. Check page 8
for addresses of the VA Regional Processing Offices.
Step 2: Wait for VA to process your application and notify you of its decision concerning your eligibility for education benefits.

ADDITIONAL HELP COMPLETING APPLICATION
If you need additional help completing this application or you want information about the work study program, call VA tollfree at 1-888-GIBILL-1 (1-888-442-4551). If you use the Telecommunications Device for the Deaf (TDD), the Federal Relay
number is 711. You can also get more information about education assistance at www.va.gov.

CONTACT VA FROM OVERSEAS
Students and School Certifying Officials calling from outside the United States can contact VA by phone at:
001-918-781-5678 during business hours, 7 a.m. - 6 p.m. CST, Monday - Friday. This is not a toll-free number but the
caller will be routed to the next available customer service representative. Non-overseas customers should call the tollfree number shown in "Additional Help Completing Application" above.

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Eastern Region:
VA Regional Office
P.O. Box 4616
Buffalo, NY 14240-4616
SERVES THE FOLLOWING STATES
CO

CT

DC

DE

IA

IL

IN

KS

KY

MA

MD

ME

MI

MN

MO

MT

NC

ND

NE

NH

NJ

NY

OH

PA

RI

SD

TN

VA

VT

WI

WV

WY

APO / FPO AA

US VIRGIN ISLANDS

FOREIGN SCHOOLS
Western Region:
VA Regional Office
P.O. Box 8888
Muskogee, OK 74402-8888

SERVES THE FOLLOWING STATES
AK

AL

AR

AZ

CA

FL

GA

HI

ID

LA

MS

NM

NV

OK

OR

PR

SC

TX

UT

WA

APO / FPO AP

GUAM

PHILIPPINES

AMERICAN SAMOA

MARIANA ISLANDS

REQUEST TO OPT OUT OF INFORMATION SHARING WITH EDUCATIONAL INSTITUTIONS
The Harry W. Colmery Veterans Educational Assistance Act of 2017 (Public Law 115-48), also known as the "Forever GI Bill," requires
the Department of Veterans Affairs (VA) to make available to educational institutions information about the amount of educational
assistance to which a veteran or other eligible individual is entitled. If you are eligible for the Post-9/11 GI Bill (Chapter 33), Montgomery
GI Bill-Active Duty (Chapter 30), Montgomery GI Bill - Selected Reserve (Chapter 1606), or the Survivors' and Dependents Educational
Assistance Program (DEA) (Chapter 35), you may elect to "opt-out" of these disclosures and have VA withhold this information instead.
To request an opt-out, or for information about how to opt-out, please refer to our website at va.gov, or click https://www.va.gov/findforms/ to complete the VA Form 22-0993, Request to Opt-Out of Information Sharing with Educational Institutions.

PRIVACY ACT INFORMATION: 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., awards of benefits) as identified in the VA system of records, 58VA21/22/28, Compensation,
Pension, Education and Veteran Readiness and Employment Records - VA, published in the Federal Register. Your obligation to respond is required to obtain education
benefits. Giving us your SSN account information is voluntary. Refusal to provide your SSN by itself will not result in the denial of benefits. VA will not deny an
individual benefits for refusing to provide his or her SSN unless the disclosure of the SSN is required by a Federal Statute of law in effect prior to January 1, 1975, and
still in effect. The requested information is considered relevant and necessary to determine the maximum benefits allowable under the law. While you do not have to
respond, VA cannot process your claim for benefits unless the information is furnished as required by existing law (38 U.S.C. 3513). The responses you submit are
considered confidential (38 U.S.C. 5701). Information submitted is subject to verification through computer matching programs with other agencies.

RESPONDENT BURDEN: We need this information to determine your eligibility for education benefits (38 U.S.C. 3513 and Public Law 116-315 Section 1002). Title
38 U.S.C. allows us to ask for this information. We estimate that you will need an average of 45 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 http://www.reginfo.gov/public/do/PRAMain. 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 form.

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