Wis. Stats. Chapter 45	2135 Rimrock Road, P.O. Box 7843, Madison, WI 53707-7843 (608) 266-1311 | 1-800-WIS-VETS (947-8387) | WisVets.com
VETERANS EDUCATION GRANT APPLICATION
Personal information you provide may be used for secondary purposes [Privacy Law, s.15.04(1)(m)].
The provision of your social security number is voluntary. Failure to provide your social security number may result in an information processing delay.
STUDENT INFORMATION
WARNING: This application (form WDVA 2200) is due with all student information completed, signed, and date stamped at either the Wisconsin Department of Veterans Affairs (WDVA) central office or in an authorized agent’s office no later than 60 days after the start of the course, term, or semester for which reimbursement is requested. All forms must be date stamped electronically or physically at the time of submission.	WDVA #
County
Name	School
Street	Social Sec #	(optional)
City	State	Zip	Telephone
Approximate date that semester, term, or course started	ended
For this semester:	Enrolled Credits:	Estimated Reimbursement:	$
Member of the National Guard?	Yes No	Eligible for NG Tuition Assistance?	Yes No (If "No," documentation is required)
Member of the Reserves?	Yes No	Eligible for Reserve Tuition Assistance?	Yes No (If "No," documentation is required)
Did you have a degree prior to the start of this course(s)?	None Associate Bachelors Post-graduate
List all financial aid available to you, or to the school in your name, for full or partial payment of your tuition whether or not you actually applied for or received it. Loans or aid that is not specifically for tuition (such as BEOG, SEOG, PELL, WHEG, Montgomery GI Bill), should not be listed. If aid is not available, indicate by checking each "None Available" box.
Federal VA Vocational Rehabilitation (Chap. 31)	Yes Amount: $	None Available
Federal Post-9/11 GI Bill (Chap. 33)	Yes Amount: $	None Available
State Vocational Rehabilitation (DVR)	Yes Amount: $	None Available
Employer Tuition Assistance	Yes Amount: $	None Available
Wisconsin GI Bill	Yes Amount: $	None Available
Other (specify source)	Amount: $	None Available
I have read and understand the warning listed above.
I understand that my grant application may be denied if WDVA determines that I have a child support or maintenance obligation and the payments are delinquent.
I certify that the information above is true, accurate and complete, and that I will promptly notify WDVA of any changes. I consent to the release by my school and the County Veterans Service Office (CVSO) of all information necessary to process this grant application.
I consent and authorize the Wisconsin Department of Revenue to release my tax records necessary to process this grant application.
Signature	Date
FOR SCHOOL VETERANS’ OFFICIAL USE ONLY
Completed applications must be submitted to WDVA central office no later than 60 days following the last day of a course, term, or semester. A completed application has all of the following items filled in and is signed and dated by an authorized school official.
Did the student have a Bachelors Degree or equivalent prior to the start of this course(s)?	Yes	No
For Minnesota schools only: This student received a waiver of nonresident tuition at this
institution under the Minnesota–Wisconsin Reciprocity Agreement.	Yes	No
Semester, term, or course start date	End Date
Total credits for which enrolled	Grade Point Average for this term
Enrolled courses: All Tuition Costs $	All Fee Costs $	Total Costs $
UWS and WTCS schools calculate equivalent tuition and fee remission under the WI GI Bill. (Other schools enter zero [0]).
Tuition: $	Fees (Segregated for UWS; Material for WTCS) $	Total Under WI GI Bill $
Did the student receive financial aid specifically for tuition from an employer, the federal government (Post-9/11 GI Bill), or other source?
Yes	No
If "Yes," name the source	Amount $
I certify that the information provided above is accurate and correct.
SVO Signature	Date
COMMENTS
Approval	Grant Amount	Voucher Date	Credit Bank Balance	Your 10–year Delimiting date is
Your costs exceeded UW–Madison's cost for
the same # of Credits