(X)
DAYS
MONDAY
APPLICATION FOR WORK-STUDY ALLOWANCE
PART I - IDENTIFICATION INFORMATION
VA FORM
JUN 2024
22-8691
OMB Approved No. 2900-0209
Respondent Burden: 15 minutes
Expiration Date: 06/30/2027
1. NAME OF APPLICANT (First, Middle, Last)
SUPERSEDES VA FORM 22-8691, APR 2021,
WHICH WILL NOT BE USED.
PRIVACY ACT INFORMATION: VA will not disclose information collected by this information collection to any source other than what has been authorized by the Privacy Act of 1974 or
Title 38 Code of Federal Regulations 1.576 for routine uses 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 at http://www.rms.oit.va.gov/SOR_Records/58VA21_22.asp. An example of a routine use allows VA to send educational forms
or letters with a veteran's identifying information to the veteran's school or training establishment to (1) assist the veteran in the completion of claims forms or (2) for VA to obtain further
information as may be necessary from the school for VA to properly process the veteran's education claim or to monitor his or her progress during training. Your obligation to respond is
"required to obtain or retain benefits". We cannot pay you any work-study benefits until we receive this information (38 U.S.C. 3485). Your responses are confidential (38 U.S.C. 5701). Any
information provided by applicants may be subject to verification through computer matching programs with other agencies.
15. SIGNATURE OF APPLICANT (Sign in ink) (Do no print) By signing this box, I, the applicant, understand that I may
not engage in VA Work Study duties until approved by VA.
10. HAVE YOU EVER PARTICIPATED IN THE VA WORK-STUDY
PROGRAM BEFORE?
(If "YES," please state where you worked)
11. WORK SITE PREFERENCE (Tell us the school, VA facility or other government
facility where you would prefer to do VA related work. Be specific as many facilities
have the same name or perform the same services in different locations or cities.)
PART III - WORK STUDY INFORMATION
16. DATE SIGNED
9. ADVANCE PAYMENT - DO YOU WANT AN ADVANCE PAYMENT? (See instructions for information on advance payment on reverse under "How Much Can I Earn?")
WHEN AVAILABLE (From & To)
FEMALE
FRIDAY
TUESDAY
WEDNESDAY
THURSDAY
5. EDUCATION BENEFIT RECEIVING
8. NEXT ENROLLMENT PERIOD YOU PLAN TO ATTEND
2. MAILING ADDRESS OF APPLICANT
(Number, and street or rural route, city or
P.O., State and 9 digit ZIP Code) (Include your email address to receive electronic
student payment letters)
MALE
B. ENDING DATE
(Month, Day, Year)
A. BEGINNING DATE
(Month, Day, Year)
A. BEGINNING DATE
(Month, Day, Year)
B. ENDING DATE
(Month, Day, Year)
7. CURRENT ENROLLMENT INFORMATION
3A. VA FILE NUMBER
(For chapter 35, enter the veteran's file number.
Be sure to include the suffix indicator. For dependent's transfer of
entitlement cases, enter the file number of the person who transferred
entitlement to you)
3B. SOCIAL SECURITY NUMBER (If not shown in Item 3A)
3C. DATE OF BIRTH OF APPLICANT (Month, Day, Year)
3D. SEX OF APPLICANT
4. TELEPHONE NUMBERS
(Include Area Code Home/Cell)
TRANSFER OF ENTITLEMENT PROGRAM (Parent or Spouse entitled to benefits)
CHAPTER 35 (Dependents Educational Assistance)CHAPTER 30 (Montgomery GI Bill - Active Duty)
CHAPTER 32 (Veterans Educational Assistance Program)
PART II - SCHOOL INFORMATION
6A. NAME AND COMPLETE ADDRESS OF SCHOOL 6B. CURRENT ACADEMIC OR TRAINING PROGRAM
NO
12. WORK EXPERIENCE
(Tell us about the jobs you had before,
other than VA work-study jobs. Please be as specific as possible.
If you have no work experience, place "NONE" in this space. If
needed, attach a separate sheet with your work-history)
YES
YES NO
14. QUALIFICATIONS
(Tell us about any special qualifications you have based on your education or work experience. Also, tell us what kinds of jobs interest you.
If needed, attach a separate sheet with this information)
4A. EMAIL ADDRESS (If applicable)
CHAPTER 31 (Veteran Readiness and Employment)
CHAPTER 1606 (Montgomery GI Bill - Selected Reserve)
CHAPTER 33 (Post- 9/11 GI Bill)(Including Fry and STEM Scholarships)
13. SPECIFY THE DAYS AND HOURS DURING THE WEEK YOU ARE AVAILABLE TO WORK
RESPONDENT BURDEN: An agency may not conduct or sponsor, and a person is not required to respond to a collection of information unless it displays a currently valid OMB control
Number. The OMB control number for this project is 2900-0209, and it expires 06/30/2027. Public reporting burden for this collection of information is estimated to average 15 minutes per
respondent, per year, including the time for reviewing instructions, searching existing data sources, gathering and maintaining the data needed, and completing and reviewing the collection of
information. Send comments regarding this burden estimate and any other aspect of this collection of information, including suggestions for reducing the burden to VA Reports Clearance Officer
at
[email protected]. Please refer to OMB Control No. 2900-0209 in any correspondence. Do not send your completed VA Form 22-8691 to this email address.