DD Form 2961, SEP 2013
OMB No. 0704-0501 RCS: DD-P&R(AR)2536
OMB Control Number: 2900-0797 Expiration Date: 12/31/2018

1 Education Benefits & Issue
Education Benefits Used
Please check all that apply *
VA Education Programs (e.g. GI Bill)






Military Tuition Assistance (Title 10)

Other
Describe Your Issue
Which best describes your issue? (Select all that apply) *





* Required
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Complaint Information


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Please DO NOT enter Personally Identifiable Information (PII), specifically Social Security numbers, account numbers, financial information, VA claim number, or dates of birth.
School/Employer Information
Name *






* Required
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Filing Information
I am filing on behalf of
Complainant Information



Your Contact Information


Telephone (include area code)





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Summary
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Education Benefits & Issue

Education Benefits Used
Describe Your Issue

Complaint

Describe what happened so we can understand the issue.
What do you think would be a fair resolution to your issue?

School/Employer

School/Employer

Level of Study
Out-Of-Pocket Tuition
Government Tuition Credit

Complainant & Contact

Filed on Behalf of
Service Affiliation
Service Status
Branch
Age

Name
Address
Telephone
Email

 


Search for your school/employer. A search can be done on school/employer name and/or state. Once you find it click on the name in the results list.


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