22-0839 Yellow Ribbon Program Agreement

OMB Control No. 2900-0718
Respondent Burden: 14 Hours
Expiration Date: 10/31/2025

YELLOW RIBBON PROGRAM AGREEMENT
(Under Chapter 33 of title 38, United States Code)

IMPORTANT: Please read the instructions for VA Form 22-0839 on pages 4 through 6 before completing the form.
NAME OF INSTITUTION OF HIGHER LEARNING (IHL)

FACILITY CODE

(Check one)
MAILING ADDRESS OF INSTITUTION OF HIGHER LEARNING

PUBLIC IHL

PRIVATE IHL

AGREEMENT TYPE (Check one)

DATE RECEIVED
(For VA Use Only)

NEW OPEN-ENDED AGREEMENT
MODIFICATION TO EXISTING AGREEMENT
WITHDRAWAL OF YELLOW RIBBON AGREEMENT

NOTE: If selecting withdrawal of agreement, only the
signature of authorizing official and date are required.

The above named institution of higher learning (IHL) agrees to participate in the Yellow Ribbon Program under the Post-9/11 GI Bill
(authorized under title V of Public Law 110-252) subject to the terms, conditions, and representations provided in this agreement and
applicable VA regulations.
1. For all U.S. schools, once this agreement is accepted by VA, it will be considered an open-ended agreement that is in effect for
the entire upcoming academic year and all future academic years unless VA or the institution notifies the other party that changes
are requested during the annual open season enrollment period, March 15th - May 15th (or the following Monday if May 15th falls
on a Saturday or Sunday). Foreign schools must apply annually due to currency exchange fluctuations. The annual open season
enrollment period for foreign schools is June 1st - July 31st (or the following Monday if July 31st falls on a Saturday or Sunday.)
Withdrawal or modifications to the terms shall be indicated in Agreement Type above. Modifications made during the open
enrollment period will go into effect for the subsequent academic year and will be posted to our website at www.gibill.va.gov when
the open enrollment period ends. Please see Page 6 of this form for information about how to submit the completed form.
2. The IHL agrees to provide contributions to eligible individuals who apply for such program at the institution (in a manner
prescribed by the institution) on a first-come-first-served basis. Funds for Yellow Ribbon contributions may derive from any
source of institutional funding that is not already allocated or awarded for a non-Yellow Ribbon purpose. Student ledgers must
denote contributions as "Yellow Ribbon." Yellow Ribbon funds cannot be denoted as any type of grant, scholarship or other fund
sources that would be applied to the student's account regardless of Yellow Ribbon program participation.
3. The IHL agrees to provide contributions on behalf of a participating individual during the current academic year and all
subsequent academic years in which the IHL participates in the Yellow Ribbon Program, provided that the individual maintains
satisfactory progress, conduct, and attendance according to the regularly prescribed standards of the institution.
4. The IHL agrees to provide the maximum amount of contributions payable toward the net cost for each participating individual
during each term, quarter, or semester the individual is enrolled if the IHL's total contribution toward the individual's net cost for
the term, quarter, or semester does not exceed the maximum dollar amount payable during the academic year as specified in
paragraph 6 of this agreement.
5. The IHL agrees to provide Yellow Ribbon Program contributions for up to _________________ eligible individuals during
the ________________ academic year and all subsequent academic years unless VA is notified of changes during any subsequent
open-enrollment period.
6. U.S. Schools only: The IHL agrees to provide Yellow Ribbon Program contributions for each participant during the academic
year up to the following amounts (fill in all applicable fields):
A. MAXIMUM NUMBER
OF STUDENTS

B. DEGREE LEVEL
(Undergraduate, Graduate,
Doctoral, or All)

C. COLLEGE OR PROFESSIONAL
SCHOOL

D. MAXIMUM
CONTRIBUTION
AMOUNT
(NOTE: Enter dollar amount
or write in "Unlimited.")
$
$
$
$
$
$
$
$
$
$
$
$

(Attach additional listings if necessary)
VA FORM
MAR 2024

22-0839

SUPERSEDES VA FORM 22-0839,OCT 2018,
WHICH WILL NOT BE USED.

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7. Foreign Schools only: The annual open season enrollment period for foreign schools is June 1st - July 31st (or the following Monday if July
31st falls on a Saturday or Sunday. The IHL must apply annually due to currency exchange fluctuations. The IHL agrees to provide Yellow
Ribbon Program contributions as indicated below. You must report in the official currency of record for the institution. Per 38 CFR 21.9640,
foreign currency will be converted into United States dollars using the foreign exchange conversion rate as published by the Federal Reserve
effective on the first day of July that precedes the relevant academic year. The IHL agrees to provide these contributions for each eligible
participant during the academic year up to the following amounts (fill in all applicable fields):

A. MAXIMUM NUMBER
OF STUDENTS

B. DEGREE LEVEL
(Undergraduate, Graduate,
Doctoral, or All)

C. CURRENCY TYPE USED FOR
SCHOOL BILLING

(example) 10

Graduate

European Euro

D. MAXIMUM
CONTRIBUTION AMOUNT
(NOTE: Enter amount per student
or write in "Unlimited.")
€

2,000

8. An IHL with multiple branch campuses that wishes to submit a single Yellow Ribbon Program agreement covering more than one branch
campus agrees to submit a document listing all branch campuses covered under this agreement as an addendum to this agreement. The listing
must include the name, address, and facility code of each branch campus. Please note that any location with an "X" as the 3rd position for its
facility code should NOT be included (Example: Facility Code 3-2-X000-00). The IHL further certifies that all branch campuses covered under
this agreement are subject to the authority of the authorizing official signing the agreement, and each branch campus has a certifying official or
other employee who meets the requirements of section 21.4266(f)(3)(ii) of title 38, Code of Federal Regulations, and has access to the terms of
this agreement.
9. This agreement is entered into under the authority of section 3317 of title 38, United States Code (as added by section 5003 of Public Law
110-252, effective August 1, 2009) and section 21.9700 of title 38, Code of Federal Regulations. The terms of this agreement will be effective
for the entire academic year beginning on the first day of August following the date of acceptance by a duly authorized officer of VA, and all
subsequent academic years unless VA is notified of changes during any subsequent open enrollment period.
10. The terms of this agreement will be available for public viewing on VA's GI Bill website at www.gibill.va.gov.
11. Completed agreements (with the original signature of an official legally authorized to bind the IHL to this agreement) must be received by
VA no later than May 15th (or the following Monday if May 15th falls on a weekend). Late agreements will not be accepted. The agreement,
once accepted by VA, will be considered an open-ended agreement. See Page 1 for information pertaining to modification of terms.
12. The IHL certifies that at least 1 of its VA-approved programs has tuition and/or fees that exceed the maximum rates payable by the
Post-9/11 GI Bill at the time this document is being submitted.

13. Points of contact:
School Financial Representative/
Yellow Ribbon Program Point of Contact (POC)
Name (First, middle, last)

Telephone No. (Include Area Code)

E-mail

School Certifying Official
Name (First, middle, last)

Telephone No. (Include Area Code)

E-mail

PRIVACY ACT INFORMATION: VA will not disclose information collected on this form to any sources other than what has been authorized under the Privacy
Act of 1974 or Title 38, Code of Federal Regulations, Section 1.526 for routine uses (e.g. VA sends education 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 the VA to obtain further information as may be
necessary from the school for the 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.
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 2900-0718, and it expires October 31, 2025. Public reporting burden for this
collection of information is estimated to average 14 hours 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 VACOPaperworkReduAct@va.gov. Please
refer to OMB Control No. 2900-0718 in any correspondence. Do not send your completed VA Form 22-0839 to this email address.
VA FORM 22-0839, MAR 2024

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AGREED TO:

SIGNATURE OF AUTHORIZING OFFICIAL

TITLE OF AUTHORIZING OFFICIAL

TELEPHONE NUMBER

DATE SIGNED

PRINT NAME OF AUTHORIZING OFFICIAL

ACCEPTED BY:
SIGNATURE OF VA OFFICIAL

VA FORM 22-0839, MAR 2024

FOR VA USE ONLY
DATE SIGNED

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INSTRUCTIONS FOR VA FORM 22-0839
YELLOW RIBBON PROGRAM AGREEMENT
Please read through the instructions before completing the Yellow Ribbon Program Agreement. If you have any
issues completing the form, please send an e-mail to Yellow.Ribbon@va.gov with any inquiries.
General Eligibility
The institution must be an Institution of Higher Learning (IHL) that offers programs of education approved for VA
benefits. U.S. schools are defined as those located in the United States or as a branch campus of such institution
located outside of the United States. Foreign schools are eligible to participate as of August 1, 2021.
Name, Address, & Facility Code
Enter the name, mailing address, facility code, and check the type of agreement, and the category of the IHL.
Items 1-4
By signing and submitting this form to VA, the IHL agrees to adhere to the provisions listed in Items 1-4.
Item 5
Enter the total number of students for which the IHL will provide Yellow Ribbon Program contributions.
The total number of students entered here should equal the sum of students listed in column A of the table in Item
6. Enter the dates of the upcoming academic year (e.g. 2020-2021) for which the agreement is being submitted.
(NOTE: An academic year for VA purposes is August 1 to July 31.)
Item 6 (U. S. SCHOOLS ONLY)
A. Maximum Number of Students - Enter the maximum number of students eligible for the specific contribution.
If the IHL wishes to offer Yellow Ribbon Program contributions to an unlimited number of qualifying students, enter
unlimited.
B. Degree Level - Specify the degree level (undergraduate, graduate, doctoral, all) of students for which the
specific contribution will be provided.
C. College or Professional School - This column may be left blank, or specify the appropriate sub-element
(college or professional school) of the institution for which students must be enrolled to receive the specific
contribution. Please be advised that an IHL cannot list a specific degree program (e.g., Masters of Business
Administration, Juris Doctorate, Bachelor of Science in Nursing, etc.)
D. Maximum Contribution Amount - Specify the maximum annual contribution amount to be provided for each
student eligible for the specific contribution. Do not enter the maximum amount payable by term or credit hour. If
the IHL wishes to provide 50% of the unmet established charges for each student eligible for the specific
contribution, please enter unlimited.
NOTE: IHLs must complete columns A and D for each contribution listed. IHLs must also complete column B, C,
or both B and C for each contribution listed.

EXAMPLE:
A. MAXIMUM NUMBER
OF STUDENTS

B. DEGREE LEVEL
(Undergraduate, Graduate,
Doctoral, or All)

10

Undergraduate

15

All

20

Graduate

VA FORM 22-0839, MAR 2024

D. MAXIMUM
CONTRIBUTION
AMOUNT

C. COLLEGE OR PROFESSIONAL
SCHOOL
$

2,000

School of Liberal Arts

$

1,000

School of Business

$

5,000

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INSTRUCTIONS FOR VA FORM 22-0839
YELLOW RIBBON PROGRAM AGREEMENT (Continued)
Item 7 (FOREIGN SCHOOLS ONLY)
A. Maximum Number of Students - Enter the maximum number of students eligible for the specific contribution. If
the IHL wishes to offer Yellow Ribbon Program contributions to an unlimited number of qualifying students, enter
unlimited.
B. Degree Level - Specify the degree level (undergraduate, graduate, doctoral, all) of students for which the
specific contribution will be provided. Please be advised that an IHL cannot list a specific degree program (e.
g., Master's of Business Administration, Juris Doctorate, Bachelor of Science in Nursing, etc.)
C. Currency used by School's Billing System - Specify the currency type used by your school for student billing.
This can be stated by the currency's officially recognized name or you can provide the International Organization
for Standardization (ISO) 4217 code. Example: European Euro or EUR
D. Maximum Contribution Amount - Specify the maximum annual contribution amount to be provided for each
student eligible for the specific contribution. Do not enter the maximum amount payable by term or credit hour. If
the IHL wishes to provide 50% of the unmet tuition and fees for each student eligible for the specific contribution,
please enter unlimited. You must answer in the currency used for student billing at your institution. Do not
report in U.S. dollars. You must report in the official currency of record for the institution. Your stated
contribution for each eligible student will be converted into U.S. dollars using the foreign exchange conversion
rate published by the Federal Reserve effective on the first day of July preceding the relevant academic year. VA
will make a matching contribution in U.S. dollars up to 50% of the unmet tuition and fees for each eligible student.
NOTE: IHLs must complete columns A, B and C for each contribution listed in column D.
EXAMPLE 1:
A. MAXIMUM NUMBER
OF STUDENTS

B. DEGREE LEVEL
(Undergraduate, Graduate,
Doctoral, or All)

10

Undergraduate

D. MAXIMUM
CONTRIBUTION
AMOUNT

C. CURRENCY TYPE USED FOR
STUDENT BILLING

CANADIAN DOLLAR (CAD) $

2,000

EXAMPLE 2:
A. MAXIMUM NUMBER
OF STUDENTS

B. DEGREE LEVEL
(Undergraduate, Graduate,
Doctoral, or All)

C. CURRENCY TYPE USED FOR
STUDENT BILLING

15

All

BRITISH POUND (GBP)

D. MAXIMUM
CONTRIBUTION
AMOUNT

£

718.15

Item 8
IHLs may enter into a centralized Yellow Ribbon Program agreement. If an IHL has multiple branch campuses
(that are all subject to the authority of the official signing the agreement) and wants to use the same contribution
information for multiple branch campuses, it may do so by attaching and submitting a document listing all branch
campuses covered under this agreement as an addendum to this agreement which lists name, mailing address,
and facility code of each participating branch campus. Please note that any location with an "X" as the 3rd
position for its facility code should NOT be included (Example: Facility Code 3-2-X000-00).
NOTE: Each branch campus will be held to the terms specified in the agreement.
Items 9 and 10
Self-explanatory.
Item 11
Yellow Ribbon Program Agreements must be received by VA no later than May 15th (or the following Monday if
May 15th falls on a Saturday or Sunday) to be considered for participation.
VA FORM 22-0839, MAR 2024

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INSTRUCTIONS FOR VA FORM 22-0839
YELLOW RIBBON PROGRAM AGREEMENT (Continued)
Item 12
By signing and submitting this agreement, an IHL certifies that, as of the date the agreement is signed, at least
one of its VA approved programs is assessed tuition and/or fees that exceed the maximum amounts payable in
the state or territory under the Post-9/11 GI Bill.
Item 13
Enter the contact information for the school financial representative/Yellow Ribbon Program Point of Contact
(POC) and the School Certifying Official. These contacts may or may not be the same individual. (Please ensure
that the information is legible.)
SIGNATURE OF AUTHORIZING OFFICIAL
The signature must be from an official legally authorized to bind the institution to this agreement with the VA. The
title, telephone number, and date must be provided. Agreements will not be processed without a valid signature.
FORM SUBMISSION
The preferred method is via email. Confirmation of email constitutes VA's receipt of the agreement and should be
maintained for the IHL's records. Only submit one signed agreement. The institution will receive an approved
agreement and accompanying letter or other related communication.
This form must be submitted in the following manner:
Via e-mail to Yellow.Ribbon@va.gov. When submitting via e-mail, please attach a scanned copy of the signed
form. (VA cannot process applications received without a signature.)
When sending via email, retain proof of submission (email).

VA FORM 22-0839, MAR 2024

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