College Fee Waiver

SAN BERNARDINO COUNTY DEPARTMENT OF VETERANS AFFAIRS

COLLEGE FEE WAIVER PROGRAM FOR VETERAN DEPENDENTS

I. STUDENT INFORMATION

First Name

Middle Initial

Last Name

Social Security Number

Date of Birth

Marital Status

Relationship to Veteran

Street Address

City

State

Zip Code

Telephone Number

VA EDUCATIONAL BENEFITS UNDER CHAPTER 35

Eligible to receive Chapter 35 Benefits

Currently receiving Chapter 35 Benefits

Adjusted Gross Income

Annual Value of Support from Parent

Upload annual income verification documentation

Accepted formats: PDF, JPG, PNG, DOC, DOCX

II. SCHOOL INFORMATION

California College or University

Academic Year

III. VETERAN'S INFORMATION

First Name

Middle Initial

Last Name

SSN or VA Claims Number

Date of Birth

Is the Veteran Alive?

Branch of Military Service

Begin Date of Active Duty

End Date of Active Duty

Street Address

City

State

Zip Code

Phone Number

Current Disability Percentage

SIGNATURES

I hereby certify under penalties of perjury that the information contained in this application and supporting documents is given for the purpose of obtaining educational benefits and is true, correct, and complete.

Student Signature

Student Signature Date

Veteran Signature

(If veteran is unable to sign, parent/veteran spouse must complete and attach a VSD-021 form)

Signature Date

VSD-021 Form

Upload this form if the veteran is unable to provide a signature. Accepted formats: PDF, JPG, PNG, DOC, DOCX

ADDITIONAL ATTACHMENTS (Optional)

Upload additional supporting documents

You can select multiple files. Accepted formats: PDF, JPG, PNG, DOC, DOCX