Form 22-10272 APPLICATION FOR REIMBURSEMENT OF PREPARATORY (PREP) COUR

OMB Control No. 2900-0892
Respondent Burden: 15 Minutes
Expiration Date: XXXXXXXX

APPLICATION FOR REIMBURSEMENT OF PREPARATORY (PREP)
COURSE FOR LICENSING OR CERTIFICATION TEST
(See General Information and Instructions on Page 3)

Please read the Privacy Act and Respondent Burden information on Page 2 before completing the form.
IMPORTANT: Reimbursement is available only for the Post 9/11 GI Bill benefit (Chapter 33) or Survivors' and Dependents' Educational Assistance
(Chapter 35) programs. Complete this application to apply for reimbursement of a Prep Course designed to prepare you for a Licensing or Certification Test (one
course per form). In order for a Prep Course to be reimbursed, you must apply and establish eligibility separately for either Chapter 33 or Chapter 35 by completing
either VA Form 22-1990, Application for VA Education Benefits or VA Form 22-5490, Dependents' Application for VA Education Benefits, if not done so already.
If you need to apply first, please visit our website at www.va.gov/education/how-to-apply. (SEE INSTRUCTIONS ON PAGE 2 BEFORE COMPLETING THIS
FORM.)
PART I - IDENTIFICATION INFORMATION
1. APPLICANT'S NAME: (First, Middle Initial, Last Name)
2A. MAILING ADDRESS (Complete Street Address, City, State and 9-digit ZIP Code)

2B. APPLICANT'S EMAIL ADDRESS:
3. TELEPHONE NUMBER: (Include Area Code)

HOME:

MOBILE:

4. VA FILE NUMBER

(VA may have assigned an eight-digit number because you or the vet
didn't have a Social Security Number. Include the Suffix, if known.)

5. PAYEE NUMBER (If applicable)

PART II - VA EDUCATION INFORMATION
6A. HAVE YOU PREVIOUSLY APPLIED FOR VA EDUCATION BENEFITS? (Please check the appropriate box below:)

YES (If "Yes," show the specific benefit you previously applied for in Item 6B)
NO (If "No," you must also complete either VA Form 22-1990, Application for VA Education Benefits, or
VA Form 22-5490, Dependents' Application for VA Education Benefits)
6B. WHAT EDUCATION BENEFIT(S) HAVE YOU APPLIED FOR PREVIOUSLY?

PART III - LICENSING OR CERTIFICATION TEST (Specify the test)
7. NAME OF TEST

8. NAME OF ORGANIZATION AWARDING LICENSE OR CERTIFICATION (Include address)

PART IV - PREP COURSE INFORMATION (Specify each item for this Prep Course)
12. ITEMIZE PREP COURSE COST INCLUDING FEES (Attach receipt)

9. NAME OF COURSE

10. ORGANIZATION GIVING PREP COURSE (Please include address)

TAKEN ONLINE?

YES

NO

11A. COURSE START DATE (MM/DD/YYYY) 11B. COURSE END DATE (MM/DD/YYYY)

VA FORM
XXXX

22-10272

Page 1

PART IV - PREP COURSE INFORMATION - Continued (Specify each item for this Prep Course)
13. INCLUDE VERIFICATION OF ENROLLMENT FROM YOUR PREP COURSE PROVIDER. THE PROVIDER HAS AGREED TO MAKE THIS AVAILABLE TO YOU.
(Submit verification with this application.)

14. REMARKS

PART V - CERTIFICATION AND SIGNATURE OF APPLICANT
I CERTIFY THAT the information above is true and correct to the best of my knowledge and belief.
PENALTY - Willfully false statements as to a material fact in a claim for education benefits payable by VA may result in a fine, imprisonment, or both.
15. SIGNATURE OF APPLICANT

16. DATE SIGNED (MM/DD/YYYY)

IMPORTANT - Please return this form to the VA Regional Processing Office that handles your area (see the VA Regional Processing Office addresses on Page 3
of this form). You must include a receipt or proof of payment for the Prep Course. Please visit https://benefits.va.gov for more information.
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, section 1.576 for routine uses (e.g., VA sends 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) 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 voluntary. While you do not have to respond, VA cannot process your claim for reimbursement of Licensing and Certification test fees
unless the information is furnished as required by existing law (38 U.S.C. 3471). The responses you submit are considered confidential (38 U.S.C. 5701). Any
information provided by applicants, recipients, and others may be subject to verification through computer matching programs with other agencies.
RESPONDENT BURDEN: We need this information to determine your eligibility for reimbursement for a Preparatory Course. We cannot reimburse you for a
Preparatory Course until we receive this information (38 U.S.C. 5101). Title 38, United States Code, allows us to ask for this information. We estimate that you will
need an average of 15 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 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 information collection.
VA FORM 22-10272, XXXX

Page 2

INFORMATION AND INSTRUCTIONS

(The items that are considered self-explanatory are not included in these instructions)

ITEM 4. Your VA FILE NUMBER is the number that appears on your VA benefit payments and all mail that we've sent to you. Generally, your
VA FILE NUMBER is the social security number of the individual on whose account you are receiving benefits. Your SUFFIX (letter or 2-digit
number) indicates your relationship to the qualifying individual.
ITEM 6A. If you have not previously applied for VA education benefits, required in order to determine your eligibility for any educational
assistance, go to https://www.va.gov/education/how-to-apply/.
ITEM 7. Write the complete name of the Licensing or Certification test you plan to take in the future. In order to be reimbursed for a Prep Course,
it must prepare you for a Licensing or Certification test.
ITEM 8. Write the complete name and address of the organization that administers the License or Certification test you plan to take.
ITEM 9. Write the complete name of the Prep Course that you took. Show information for only one Prep Course on any one application.
ITEM 10. Write the complete name and address of the organization that provided the Prep Course you took.
ITEM 11. Show the dates you attended the Prep Course.
ITEM 12. Enter the cost of the Prep Course you took, including any required fees. (We can only reimburse you for mandatory fees.) We have no
authority to reimburse you for any optional costs related to the Prep Course process. Course fees that VA will reimburse include "registration fees,"
mandatory fees for supplies, and administrative fees. Fees that VA has no authority to reimburse include fees to take pre-exams (such as Kaplan
exams), or other costs or fees for optional items that are not required to take an approved Prep Course.
ITEM 13. Attach the Verification of Enrollment received from the provider of the Prep Course.
ITEM 14. Use the space in this item to provide information that does not fit elsewhere on this form or that will help VA process your claim. Refer
to other item numbers on this form to help us match your answers to the correct questions. If more space is needed, please attach separate sheets of
paper. Be sure to place your name and VA file number on each additional page.
MORE HELP: Our education internet site (www.benefits.va.gov/gibill) is available to help you, even after normal business hours. If you need
help in completing this application, call VA TOLL-FREE at 1-888-GI-BILL-1 (1-888-442-4551). If you use the Telecommunications Device for
the Deaf (TDD), the Federal Relay number is 711.
HOW TO FILE YOUR CLAIM. Send the completed application to the Regional Processing Office in the region of your home address. Use the
addresses shown below.

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
VA FORM 22-10272, XXXX

GUAM

PHILIPPINES

AMERICAN SAMOA

MARIANA ISLANDS
Page 3