CSM VA Education Benefits Intake Form
Name
*
First Name
Last Name
Email
*
example@example.com
Student ID Number
Address
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Phone Number
*
Please enter a valid phone number.
Format: (000) 000-0000.
Please select your intended program of study
*
Please Select
ACCOUNTING-AAS
ART-AA
ARTS AND SCIENCES-AA
BUSINESS ADMINISTRATION-AS
BUSINESS MANAGEMENT-AAS
CLOUD AND INFORMATION TECHNOLOGY-AAS
COMPUTER ENGINEERING-ASE
COMPUTER SCIENCE WITH CLOUD COMPUTING-AS
COMPUTER SCIENCE-AS
CONSTRUCTION MANAGEMENT-AAS
CRIMINAL JUSTICE-AS
CYBERSECURITY-AAS
DATA SCIENCE-AS
DIGITAL MEDIA PRODUCTION-AA
EARLY CHILDHOOD DEVELOPMENT-AAS
EARLY CHILDHOOD EDUCATION-AAT
ELECTRIC POWER TECHNICIAN-AAS
ELECTRIC WIRING TECHNICIAN-AAS
ELECTRICAL ENGINEERING-ASE
ELEMENTARY EDUCATION-GENERIC SPECIAL-AAT
EMERGENCY MEDICAL SERVICES-AAS
ENGINEERING TECHNOLOGY-AAS
ENGINEERING-AS
ENVIRONMENTAL STUDIES-AS
EXCERCISE AND SPORT SCIENCE-AS
FIRE SCIENCE TECHNOLOGY-AAS
GENERAL STUDIES-AA
HEALTH INFORMATION MANAGEMENT-AAS
HOMELAND SECURITY-AAS
HOSPITALITY MANAGEMENT-AAS
HUMAN SERVICES-AAS
LAW ENFORCEMENT-AAS
MARITIME OPERATIONS TECHNOLOGY-AAS
MASSAGE THERAPY-AAS
MATHEMATICS AND SCIENCES-AS
MEDICAL LABORATORY TECHNOLOGY-AAS
MUSIC-AA
NUCLEAR MEDICINE TECHNOLOGY-AAS
NURSING-AS
PHOTOGRAPHY-AAS
PHYSICAL THERAPY ASSISTANT-AAS
PRE-PROFESSIONAL HEALTH SCIENCE-AAS
PSYCHOLOGY-AA
SPORTS MANAGEMENT-AS
TEACHER EDUCATION-AA
THEATER-AA
CERT-CDL TRUCK CLASS A
CERT-CDL TRUCK CLASS B
CERT-CLINICAL MEDICAL ASSISTANT
CERT-CLOUD AND INFORMATION TECHNOLOGY
CERT-CONSTRUCTION MANAGEMENT
CERT-DATA SCIENCE
CERT-DIGITAL MARKETING MANAGEMENT
CERT-EDUCATION
CERT-ELECTRICAL HELPER CERTIFICATE
CERT-GAS METAL ARC PIPE WELDER
CERT-GAS METAL ARC WELDER
CERT-GAS TUNGSTEN ARC PIPE WELDER
CERT-GAS TUNGSTEN ARC WELDER
CERT-GERIATRIC NURSING ASSISTANT
CERT-HEALTH SCIENCES
CERT-HOSPITALITY MANAGEMENT
CERT-HUMAN SERVICES
CERT-HVAC HELPER
CERT-NETWORK ADMINISTRATOR
CERT-RETAIL MANAGEMENT
CERT-SHIELDED METAL ARC PIPE WELDER
CERT-SHIELDED METAL ARC WELDER
CERT-SMALL BUSINESS AND ENTREPRENEUR
CERT-TECHNOLOGY MANAGEMENT
CERT-LDC-ACCOUNTING-ADVANCED
CERT-LDC-ACCOUNTING-BASIC
CERT-LDC-BUSINESS ANALYSIS
CERT-LDC-BUSINESS MANAGEMENT
CERT-LDC-CONSTRUCTION MANAGEMENT
CERT-LDC-CRIMINAL JUSTICE
CERT-LDC-CYBERSECURITY
CERT-LDC-DRAFTING
CERT-LDC-EARLY CHILDHOOD DEVELOPMENT
CERT-LDC-ELECTRONICS TECHNOLOGY
CERT-LDC-EMERGENCY MED SERV PARAMEDICS
CERT-LDC-ENGINEERING TECHNOLOGY
CERT-LDC-FITNESS MANAGER-ADVANCED
CERT-LDC-FITNESS MANAGER-BASIC
CERT-LDC-GRAPHIC DESIGN
CERT-LDC-HUMAN SERVICES MENTAL HEALTH
CERT-LDC-INFORMATION SYSTEMS
CERT-LDC-MEDICAL ASSISTING
CERT-LDC-MEDICAL CODING SPECIALIST
CERT-LDC-PHARMACY TECHNICIAN
CERT-LDC-PHOTOGRAPHY
CERT-LDC-PRACTICAL NURSING
CERT-LDC-RETAIL MANAGEMENT
CERT-LDC-SMALL BUSINESS AND ENTREPRENEURSHIP
CERT-LDC-TECHNICAL SUPPORT
CERT-LOR-BUSINESS MANAGEMENT
CERT-LOR-CRIMINAL JUSTICE
CERT-LOR-SMALL BUSINESS AND ENTREPRENEURSHIP
CERT-REAL ESTATE SALES LICENSE-CH31 ONLY
Which of the following describes you? Check all that apply.
*
Veteran
Active-Duty Service Member, National Guard Member, or Member of the Reserves
Spouse of Active-Duty Service Member
Spouse of Veteran
Child of Veteran
Child of an Active-Duty Service Member
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Student's Branch of Service
Please Select
Army
Navy
Air Force
Coast Guard
Marine Corps
Space Force
Please read the following options and select the benefit you will be using
I am a guest student at CSM
Chapter 33 Post 9/11 GI Bill (Veterans)
Chapter 33 Post 9/11 GI Bill (Transfer of Entitlement)
Chapter 31 Vocational Readiness and Employment
Chapter 35 Survivors and Dependents Education Assistance Program
Tuition Assistance through a particular branch of the Armed Forces
MyCAA (My Career Advancement Account)
I am not sure what benefit I am eligible for
I am not using a military benefit at this time
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Please upload the VA Form 22-1990/1995 or your Certificate of Eligibility
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Please upload DD-214, Certificate of Eligibility and Parent School Letter
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Please upload VA Form 22-5490/5495, or Certificate of Eligibility
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Service Member's First/Last Name (not student)
Service Member's SSN for VA processing (not student)
Service Member's Branch of Service
Please Select
Army
Navy
Air Force
Coast Guard
Marine Corps
Space Force
Please upload the VA Form 22-1990e, DOD Transfer of Entitlement, or Certificate of Eligibility
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of
Request MyCAA educational training plan by checking the box below:
Have you met with the VR&E counselor?
Yes
No
Tuition Assistance Service Approved Document
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of
If you do not know which VA Education Benefit type, you will be using please contact our office at veteransbenefits@csmd.edu.
If you are not using benefits at this time, please contact our office at veteransbenefits@csmd.edu.
Please provide your VR&E Counselor Full Name
Please provide your VR&E Counselor's Email
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Do you have transcripts from other prior college/universities?
Yes
No
Have you ordered JST Transcripts?
Yes
No
I do not have JST Transcripts
By signing below, you authorize the College of Southern Maryland (CSM) VA Office to access your Joint Services Transcript (JST) account for the purpose of ordering your JST transcripts on your behalf.If you prefer to opt out of this service and do not wish to grant CSM VA Office access to your JST account, please check the box below:
I do not authorize the CSM VA Office to access my JST account.
Additional Comments
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First Name
Last Name
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