Military Education Benefits Request for Enrollment Certification

Office of Student Accounts

Yellow Ribbon Program Student Application

Please complete this application and submit with a copy of your Certificate of Eligibility from the U.S. Department of Veterans Affairs to the Office of Student Accounts. Applications are not considered completeuntil all materials are received by the institution.

Office of Student Accounts

350 North Orleans Street, Suite 1050

Chicago, IL 60654

Phone: 800.684.2890 option 3

Fax: 312.488.6336

Email:

By submitting this application, you are requesting participation in the Yellow Ribbon Program at The Chicago School of Professional Psychology. You must be eligible at the 100% benefit level to qualify for the Yellow Ribbon Program. Dependents under the Transfer of Entitlement provision could be eligible only if they are at the 100% benefit level. (Active duty personnel are not eligible for the Yellow Ribbon Program.) More information is available from the U.S. Department of Veterans Affairs:

Last Name: / First Name: Middle Initial:
Address:
Email: / Phone:
Program type: Certificate B.A. M.A. Ed.S. Psy.D. Ph.D.
Program Name:

Please initial your agreement with each of the following statements:

I meet full eligibility requirements of the Yellow Ribbon Program as established by the U.S. Department of Veterans Affairs:

With this application, I am submitting a copy of my Certificate of Eligibility from the U.S. Department of Veterans Affairs.

I have previously submitted or am simultaneously submitting an Enrollment Certification Request Form to the Office of Student Accounts.

I understand that the Yellow Ribbon Program is a supplemental scholarship granted in addition to my regular military education benefits and that I am under the same responsibilities listed on the Enrollment Certification Request Form. If I lose eligibility for my regular military education benefits, I will also lose eligibility for the Yellow Ribbon Program

I understand that there are a limited number of Yellow Ribbon Program scholarships available on a first-come-first-served basis for eligible students only. Submitting this application does not guarantee my participation in the Yellow Ribbon Program.

By checking this box I acknowledge that typing my name below will serve as my electronic signature.

Signature Date

Revised: April 2016