Form IL 497-0002 Application for Veterans' Children Educational Opportunities - Illinois

Form IL497-0002 is a Illinois Department of Veterans Affairs form also known as the "Application For Veterans' Children Educational Opportunities". The latest edition of the form was released in August 1, 2018 and is available for digital filing.

Download a PDF version of the Form IL497-0002 down below or find it on Illinois Department of Veterans Affairs Forms website.

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ILLINOIS DEPARTMENT OF VETERANS’ AFFAIRS
Submit completed application to IDVA/SAA; 833 S. Spring Street;
PO Box 19432; Springfield, IL 62794-9432 or Fax to 217/524-8394
APPLICATION FOR VETERANS’ CHILDREN EDUCATIONAL OPPORTUNITIES-Part I
♦VETERAN INFORMATION
Name of Veteran _______________________________ Veteran’s Social Security Number ______ ______ ________
Street Address (if living) _________________________ Veteran’s Date of Death (if applicable)
City/State/Zip _________________________________
County __________________________
PLEASE INDICATE ONE OF THE FOLLOWING:
Veteran is 100% permanent and totally disabled due to service connected causes
Veteran is 100% disabled due to service connected causes for two years prior to application
Veteran’s death was determined to be service connected and I currently draw DIC benefits
From the U.S. Department of Veterans’ Affairs
Veteran was Killed in Service
♦INFORMATION CONCERNING ELIGIBLE CHILD
Name of Child __________________________________
Date of Birth _____________________________
Street Address __________________________________
City/State/Zip ___________________________________
Please indicate relationship of child to veteran by selecting one of the following:
Natural Child
Adopted Child
Step Child
♦PAYMENT INFORMATION
Name of Payee _______________________________ Soc. Security Number _____________________
Person applying for Payment
Street Address ________________________________
Please indicate relationship to child by selecting
one of the following:
Mailing Address________________________________
Parent
Step Parent
Legal Guardian
If different from above
Phone (______) _______________________
City/State/Zip
____________________________________
IMPORTANT NOTICE
This state agency is requesting disclosure of information necessary to
accomplish the statutory purpose of ILCS Ch. 330, 105/1. Disclosure
DVA FORM EDI Part I (Revised, 08/2018)
is REQUIRED; failure to provide this information will prevent the
IL 497-0002
claim from being processed
ILLINOIS DEPARTMENT OF VETERANS’ AFFAIRS
Submit completed application to IDVA/SAA; 833 S. Spring Street;
PO Box 19432; Springfield, IL 62794-9432 or Fax to 217/524-8394
APPLICATION FOR VETERANS’ CHILDREN EDUCATIONAL OPPORTUNITIES-Part I
♦VETERAN INFORMATION
Name of Veteran _______________________________ Veteran’s Social Security Number ______ ______ ________
Street Address (if living) _________________________ Veteran’s Date of Death (if applicable)
City/State/Zip _________________________________
County __________________________
PLEASE INDICATE ONE OF THE FOLLOWING:
Veteran is 100% permanent and totally disabled due to service connected causes
Veteran is 100% disabled due to service connected causes for two years prior to application
Veteran’s death was determined to be service connected and I currently draw DIC benefits
From the U.S. Department of Veterans’ Affairs
Veteran was Killed in Service
♦INFORMATION CONCERNING ELIGIBLE CHILD
Name of Child __________________________________
Date of Birth _____________________________
Street Address __________________________________
City/State/Zip ___________________________________
Please indicate relationship of child to veteran by selecting one of the following:
Natural Child
Adopted Child
Step Child
♦PAYMENT INFORMATION
Name of Payee _______________________________ Soc. Security Number _____________________
Person applying for Payment
Street Address ________________________________
Please indicate relationship to child by selecting
one of the following:
Mailing Address________________________________
Parent
Step Parent
Legal Guardian
If different from above
Phone (______) _______________________
City/State/Zip
____________________________________
IMPORTANT NOTICE
This state agency is requesting disclosure of information necessary to
accomplish the statutory purpose of ILCS Ch. 330, 105/1. Disclosure
DVA FORM EDI Part I (Revised, 08/2018)
is REQUIRED; failure to provide this information will prevent the
IL 497-0002
claim from being processed
APPLICATION FOR VETERANS’ CHILDREN EDUCATIONAL OPPORTUNITIES-Part II
♦SCHOOL INFORMATION
Name of Child ____________________________________
Grade of Child __________________________
Name of School ___________________________________________________________________________
Street Address _____________________________________
Office Phone Number ____________________
City/State/Zip _______________________________________________________________________________
♦VERIFICATION OF ENROLLMENT OF CHILD
I, _____________________________________, hereby certify that the above named child is registered to attend the
Printed Name of Principal or Registrar
above named school for the following academic year ---
_____________, ____________ to ___________, ___________.
Month
Year
Month
Year
_________________________________________________
_______________________________
Signature of Principal or Registrar
Date
TO BE COMPLETED BY SCHOOL OFFICIAL ONLY
♦PAYEE CERTIFICATION
I, _________________________________, certify that the above named child has been a resident of Illinois for
one year preceding this application and will reside with me during
Printed Name of Payee
the current school year. I further state that the foregoing statements
are true and correct to the best of my knowledge.
__________________________________________
_______________________________
Signature of Payee
Date
SUBMIT WITH THE FOLLOWING EVIDENCE WHEN APPLICABLE: BIRTH CERTIFICATE,
DEATH CERTIFICATE, ADOPTION DECREES, LETTERS OF GUARDIANSHIP AND POWER OF
ATTORNEY.
IMPORTANT NOTICE
This state agency is requesting disclosure of information necessary to
accomplish the statutory purpose of ILCS Ch. 330, 105/1. Disclosure
DVA FORM EDI Part II (Revised, 08/2018)
is REQUIRED; failure to provide this information will prevent the
IL 497-0002
claim from being processed.

Download Form IL 497-0002 Application for Veterans' Children Educational Opportunities - Illinois

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