VA Form 21-674C "Request for Approval of School Attendance"

What Is VA Form 21-674c?

VA Form 21-674c, Request for Approval of School Attendance is a document used by the Department of Veterans Affairs (VA) for submitting a request for education-related compensations or benefits connected with attending a specific school or training. The individuals eligible to receive benefit payments are children of veterans between the ages of 18 and 23 who are attending school.

The latest version of the form was released by the VA in February 2012. It supersedes the currently obsolete September 2008 edition. A fillable VA Form 21-674c is available for download below or can be found on the GSA Regulatory Information Service Center website.

VA 21-674c requires entering the same information as the related VA Form 21-674, Request for Approval of School Attendance, but there are certain differences between the two forms. The 21-674c has to be printed, completed, and mailed manually, while the VA 21-674 is for electronic filing only.

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Download VA Form 21-674C "Request for Approval of School Attendance"

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SUPERSEDES VA FORM 21-674c, SEP 2008,
VA FORM
21-674c
WHICH WILL NOT BE USED.
FEB 2012
SUPERSEDES VA FORM 21-674c, SEP 2008,
VA FORM
21-674c
WHICH WILL NOT BE USED.
FEB 2012
OMB Approved No. 2900-0049
Respondent Burden: 15 minutes
1. ADDRESS OF VA OFFICE
REQUEST FOR APPROVAL OF SCHOOL ATTENDANCE
IMPORTANT: Be sure to read the Instructions on the reverse of VA File Copy 1 before completing this
form. This form should be completed in duplicate and signed in Part III. Return the original (VA File
Copy) to the VA Office shown in Item 1. The copy will be retained by the claimant.
PART I - TO BE COMPLETED BY CLAIMANT (Also sign certification in Part III)
2A. FIRST - MIDDLE INITIAL - LAST NAME OF VETERAN (Type or print)
3. VA FILE NUMBER
C/CSS
2B. E-MAIL ADDRESS OF VETERAN (If applicable)
4A. STUDENT'S SOCIAL SECURITY NUMBER
4B. FIRST NAME-MIDDLE INITIAL-LAST NAME OF STUDENT (Veteran's child attending school) (Type or print)
5A. DATE OF BIRTH
5B. HAS STUDENT EVER MARRIED?
5C. DATE OF MARRIAGE
(If "Yes," complete Item 5C)
YES
NO
6. ADDRESS OF STUDENT (Number and street or rural route,
7A. IS TUITION AND/OR ALLOWANCE FOR STUDENT'S EDUCATION OR TRAINING BEING PAID BY
VA DEPENDENTS EDUCATIONAL ASSISTANCE (DEA), THE FEDERAL EMPLOYEE'S COMPEN-
city or P.O.,State and ZIP Code)
SATION ACT OR ANY OTHER AGENCY OR PROGRAM OF THE UNITED STATES GOVERNMENT?
NO (If "Yes," complete Items 7B and 7C. If "No," skip to Item 8A)
YES
7B. AGENCY NAME
7C. DATE PAYMENTS BEGAN (Month, day, year)
8A. NAME AND ADDRESS OF SCHOOL FOR WHICH APPROVAL IS REQUESTED
8B. NAME OR TYPE OF COURSE OF EDUCATION OR TRAINING
9A. OFFICIAL BEGINNING DATE OF REGULAR TERM OR
9B. DATE STUDENT STARTED OR EXPECTS TO START
9C. EXPECTED DATE OF GRADUATION
COURSE
COURSE (Month, day, year)
(Month, day, year)
10A. IS STUDENT ENROLLED
10B. SUBJECT FOR WHICH STUDENT IS ENROLLED
10C. NUMBER OF
10D. HOURS PER WEEK
IN FULL-TIME HIGH SCHOOL
(If other than full-time high school or college course)
SESSIONS PER WEEK
OR COLLEGE COURSE?
YES
NO
(If "No," complete Items 10B,
10C and 10D)
11A. WAS STUDENT ATTENDING ANY SCHOOL AT END OF LAST
11B. NAME AND ADDRESS OF SCHOOL ATTENDED LAST TERM
SCHOOL TERM?
NO
(If "Yes," complete Items 11B through 11F)
YES
11C. NO. OF SESSIONS
11E. BEGINNING DATE OF LAST TERM
11F. ENDING DATE OF LAST TERM
11D. HOURS PER WEEK
PER WEEK
PART II - STUDENT'S INCOME AND NET WORTH (See Instructions for when required)
12. REPORT OF INCOME BY CALENDAR YEAR (IMPORTANT - Do NOT report VA benefits)
13. VALUE OF ESTATE
B. RECEIVED
C. EXPECTED
A. SOURCE
A. SAVINGS (Including cash)
(REPORT FOR YEAR IN WHICH SCHOOL TERM
(Report for year following that
$
BEGINS-SEE ITEM 9 ABOVE)
shown in column B)
EARNINGS FROM ALL
B. SECURITIES, BONDS, ETC.
EMPLOYMENT
ANNUAL SOCIAL
C. REAL ESTATE (Not your home)
SECURITY
OTHER ANNUITIES
D. ALL OTHER ASSETS
ALL OTHER INCOME
$
E. TOTAL OF ABOVE
(Interest, dividends, etc.)
14. REMARKS
PART III - CERTIFICATION AND AGREEMENT TO BE SIGNED BY CLAIMANT
NOTE: This part will be completed by the student only if he or she has attained majority and is claiming benefits in his or her own right. Otherwise, the veteran, surviving
spouse, guardian or custodian will sign and also enter his or her relationship to the student.
Receipt by the student of VA Dependents Educational Assistance (DEA), the Federal Employees' Compensation Act, or benefit from another Federal Agency (U.S.
Service Academy, U. S. Merchant Marine Academy, Bureau of Indian Affairs, etc.) with additional compensation payments based on the student's school attendance is
considered a duplication of benefits and is prohibited.
I CERTIFY THAT the information given above is true and correct to the best of my knowledge and belief and request approval of the course of education or training
shown above.
I AGREE to notify the Department of Veterans Affairs immediately of any change in this course of education, transfer to another school, discontinuance of school
attendance, receipt of Dependents Educational Assistance, or marriage prior to completion of the course. I understand that continued entitlement to school attendance
may be based on information I have furnished on this form. Any benefits allowed due to this certification will be discontinued if the student marries, receives VA
Dependents Education Assistance (DEA) benefits, leaves school, or passes away.
15A. SIGNATURE
15B. DAYTIME PHONE NO.
15C. EVENING PHONE NO.
16. RELATIONSHIP TO STUDENT 17. DATE
(Include Area Code)
(Include Area Code)
Penalty: The law provides severe penalties which include fine or imprisonment, or both, for the willful submission of any statement or
evidence of a material fact, knowing it to be false.
VA FORM
SUPERSEDES VA FORM 21-674c, SEP 2008,
21-674c
VA FILE COPY 1
FEB 2012
WHICH WILL NOT BE USED.
INSTRUCTIONS
NOTE: Read the instructions carefully before completing this form.
How do I complete VA Form 21-674c?
VA Form 21-674c should be completed by the person receiving or claiming benefits for a veteran's child who is at
least 18 but under 23 and attending school. The veteran's child should complete the form only if he or she has
reached the age of majority and is or will be entitled to receive direct payment of VA benefits. NOTE: The age of
majority is determined by State law; it is age 18 in most states.
Print all answers clearly. For additional space, attach a separate sheet, indicating the item number to which the
answers apply. Make sure to write the veteran's name and VA claim number on any attachments to this form.
Submit the original copy (VA File Copy 1) of the completed form to the VA office shown in Item 1. If no address is
shown, mail or take it to the nearest VA regional office. Keep Claimant's Copy 2 for your own records and use the
reverse, School Attendance Report, to report to VA any change in the child's status, such as termination of school
attendance or marriage.
PART I
All claimants must complete this part. Answer "Yes" to Item 7A only if, Federal Employee's Compensation, VA
Dependents Educational Assistance (DEA), or another Federal Agency (U.S. Service Academy, U.S. Merchant
Marine Academy, Bureau of Indian Affairs, etc.) is paying the student's tuition. Do not answer "Yes" simply
because the student's continuing school attendance has resulted in Social Security benefits.
PART II
Complete this part only if the benefit being claimed or received is disability pension or death pension. Each income
block must be completed. If you do not receive income from a particular source, write "0" or "none" in the space
provided. Do not leave the space blank. VA will interpret a blank space as "0" or "None". Report the gross amounts
before you take out deductions for taxes, insurance, etc.
Section 306 or Old Law Pension (entitlement to pension established before January 1, 1979): Complete this part
only if the VA benefit payable will be death pension, and there is no surviving spouse entitled to death pension. Do
not complete if the student is a dependent on a veteran's or surviving spouse's award.
Improved Pension: Complete this part showing the student's income. Educational or vocational rehabilitation
expenses are amounts paid by the student for his or her course of post-secondary education or vocational
rehabilitation, including tuition, fees, and materials. If any of these expenses are paid by the student, the expenses
may be deducted from the earned income of the student. Report the total amount(s) paid and dates of payment in
Item 14, "Remarks."
PART III
This part will be completed by the student only if he or she has reached the age of majority and is claiming benefits
in his or her own right. Otherwise, the veteran, surviving spouse, guardian or custodian will sign and also enter his
or her relationship to the student in Item 16.
Privacy Act Notice: 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 1.576 for routine uses (i.e., civil or criminal law enforcement, congressional
communications, epidemiological or research studies, the collection of money owed to the United States, litigation in which the United States is a
party or has an interest, the administration of VA programs and delivery of VA benefits, verification of identity and status, and personnel
administration) as identified in the VA system of records, 58VA21/22/28, Compensation, Pension, Education, and Vocational Rehabilitation and
Employment Records - VA, and published in the Federal Register. Your obligation to respond is required to obtain or retain benefits. The
requested information is considered relevant and necessary to determine maximum benefits under the law. Giving us your and your dependents'
SSN account information is mandatory. Applicants are required to provide their SSN and the SSN of any dependents for whom benefits are
claimed under Title 38 U.S.C. 5101(c)(1). VA will not deny an individual benefits for refusing to provide his or her SSN unless the disclosure of
the SSN is required by a Federal Statute of law in effect prior to January 1, 1975, and still in effect. The responses you submit are considered
confidential (38 U.S.C. 5701). Information submitted is subject to verification through computer matching programs with other agencies.
Respondent Burden: We need this information to determine entitlement to benefits for a veteran's child who is between age 18 and 23 and
attending school (38 U.S.C. 104(a)). 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
1-800-827-1000 to get information on where to send comments or suggestions about this form.
VA FORM 21-674c, FEB 2012
OMB Approved No. 2900-0049
Respondent Burden: 15 minutes
1. ADDRESS OF VA OFFICE
REQUEST FOR APPROVAL OF SCHOOL ATTENDANCE
IMPORTANT: Be sure to read the Instructions on the reverse of VA File Copy 1 before completing this
form. This form should be completed in duplicate and signed in Part III. Return the original (VA File
Copy) to the VA Office shown in Item 1. The copy will be retained by the claimant.
PART I - TO BE COMPLETED BY CLAIMANT (Also sign certification in Part III)
2A. FIRST - MIDDLE INITIAL - LAST NAME OF VETERAN (Type or print)
3. VA FILE NUMBER
C/CSS
2B. E-MAIL ADDRESS OF VETERAN (If applicable)
4A. STUDENT'S SOCIAL SECURITY NUMBER
4B. FIRST NAME-MIDDLE INITIAL-LAST NAME OF STUDENT (Veteran's child attending school) (Type or print)
5A. DATE OF BIRTH
5B. HAS STUDENT EVER MARRIED?
5C. DATE OF MARRIAGE
(If "Yes," complete Item 5C)
YES
NO
6. ADDRESS OF STUDENT (Number and street or rural route,
7A. IS TUITION AND/OR ALLOWANCE FOR STUDENT'S EDUCATION OR TRAINING BEING PAID BY
VA DEPENDENTS EDUCATIONAL ASSISTANCE (DEA), THE FEDERAL EMPLOYEE'S COMPEN-
city or P.O.,State and ZIP Code)
SATION ACT OR ANY OTHER AGENCY OR PROGRAM OF THE UNITED STATES GOVERNMENT?
NO (If "Yes," complete Items 7B and 7C. If "No," skip to Item 8A)
YES
7B. AGENCY NAME
7C. DATE PAYMENTS BEGAN (Month, day, year)
8A. NAME AND ADDRESS OF SCHOOL FOR WHICH APPROVAL IS REQUESTED
8B. NAME OR TYPE OF COURSE OF EDUCATION OR TRAINING
9A. OFFICIAL BEGINNING DATE OF REGULAR TERM OR
9B. DATE STUDENT STARTED OR EXPECTS TO START
9C. EXPECTED DATE OF GRADUATION
COURSE
COURSE (Month, day, year)
(Month, day, year)
10A. IS STUDENT ENROLLED
10B. SUBJECT FOR WHICH STUDENT IS ENROLLED
10C. NUMBER OF
10D. HOURS PER WEEK
IN FULL-TIME HIGH SCHOOL
(If other than full-time high school or college course)
SESSIONS PER WEEK
OR COLLEGE COURSE?
YES
NO
(If "No," complete Items 10B,
10C and 10D)
11A. WAS STUDENT ATTENDING ANY SCHOOL AT END OF LAST
11B. NAME AND ADDRESS OF SCHOOL ATTENDED LAST TERM
SCHOOL TERM?
NO
(If "Yes," complete Items 11B through 11F)
YES
11C. NO. OF SESSIONS
11E. BEGINNING DATE OF LAST TERM
11F. ENDING DATE OF LAST TERM
11D. HOURS PER WEEK
PER WEEK
PART II - STUDENT'S INCOME AND NET WORTH (See Instructions for when required)
13. VALUE OF ESTATE
12. REPORT OF INCOME BY CALENDAR YEAR (IMPORTANT - Do NOT report VA benefits)
B. RECEIVED
C. EXPECTED
A. SOURCE
A. SAVINGS (Including cash)
(REPORT FOR YEAR IN WHICH SCHOOL TERM
(Report for year following that
$
BEGINS-SEE ITEM 9 ABOVE)
shown in column B)
EARNINGS FROM ALL
B. SECURITIES, BONDS, ETC.
EMPLOYMENT
ANNUAL SOCIAL
C. REAL ESTATE (Not your home)
SECURITY
OTHER ANNUITIES
D. ALL OTHER ASSETS
ALL OTHER INCOME
E. TOTAL OF ABOVE
$
(Interest, dividends, etc.)
14. REMARKS
PART III - CERTIFICATION AND AGREEMENT TO BE SIGNED BY CLAIMANT
NOTE: This part will be completed by the student only if he or she has attained majority and is claiming benefits in his or her own right. Otherwise, the veteran, surviving
spouse, guardian or custodian will sign and also enter his or her relationship to the student.
Receipt by the student of VA Dependents Educational Assistance (DEA), the Federal Employees' Compensation Act, or benefit from another Federal Agency (U.S.
Service Academy, U. S. Merchant Marine Academy, Bureau of Indian Affairs, etc.) with additional compensation payments based on the student's school attendance is
considered a duplication of benefits and is prohibited.
I CERTIFY THAT the information given above is true and correct to the best of my knowledge and belief and request approval of the course of education or training
shown above.
I AGREE to notify the Department of Veterans Affairs immediately of any change in this course of education, transfer to another school, discontinuance of school
attendance, receipt of Dependents Educational Assistance, or marriage prior to completion of the course. I understand that continued entitlement to school attendance
may be based on information I have furnished on this form. Any benefits allowed due to this certification will be discontinued if the student marries, receives VA
Dependents Education Assistance (DEA) benefits, leaves school, or passes away.
15A. SIGNATURE
15B. DAYTIME PHONE NO.
15C. EVENING PHONE NO.
16. RELATIONSHIP TO STUDENT 17. DATE
(Include Area Code)
(Include Area Code)
Penalty: The law provides severe penalties which include fine or imprisonment, or both, for the willful submission of any statement or
evidence of a material fact, knowing it to be false.
VA FORM
SUPERSEDES VA FORM 21-674c, SEP 2008,
21-674c
CLAIMANT'S COPY 2
FEB 2012
WHICH WILL NOT BE USED.
SCHOOL ATTENDANCE REPORT
(Unscheduled Termination or Change)
INSTRUCTIONS: The appropriate items below should be completed and
the form returned to the Department of Veterans Affairs if the student
whose enrollment is recorded on the face of this form discontinues the
approved course of education or training, receives VA Dependents'
Educational Assistance (DEA) benefits, enters an educational institution
entirely supported by the Federal government, or marries prior to
completion of the course.
PART I - NOTICE OF TERMINATION OF SCHOOL ATTENDANCE
1A. DATE SCHOOL ATTENDANCE TERMINATED (Month, day, year)
1B. IS THIS THE OFFICIAL ENDING DATE OF REGULAR TERM FOR SUCH COURSE?
YES (If "Yes," complete Item 2A)
NO (If "No," complete Item 2B)
2A. BEGINNING DATE OF THE NEXT REGULAR TERM FOLLOWING THE
2B. OFFICIAL ENDING DATE OF REGULAR TERM (Month, day, year)
DATE STUDENT DISCONTINUED SCHOOL (Month, day, year)
3. REASON FOR TERMINATION OF ATTENDANCE
A. FAILURE TO START COURSE OR TRAINING
E. OTHER (Please explain)
B. FAILURE TO RESUME COURSE
C. COMPLETION OF COURSE
D. TRANSFER TO ANOTHER INSTITUTION
(Specify name and address of other institution, if known)
4. REASON FOR TERMINATION DUE TO CHANGE IN STATUS
A. RECEIPT OF VA DEPENDENTS' EDUCATIONAL ASSISTANCE (DEA) BENEFITS
B. RECEIPT OF FEDERAL EMPLOYEES' COMPENSATION ACT (FECA)
C. RECEIPT OF OTHER FEDERAL BENEFITS (Such as, U.S. Service Academy,
U.S. Merchant Marine Academy, Bureau of Indian Affairs, Job Corp, etc.)
4D. DATE OTHER FEDERAL BENEFITS BEGAN (Month, day, year)
PART II - NOTICE THAT STUDENT MARRIED
5A. DATE OF MARRIAGE
5B. MARRIED NAME (If female student)
5C. ADDRESS OF STUDENT (No. and street or rural route, city or P.O., State and ZIP Code)
6. REMARKS
I CERTIFY THAT the foregoing statements are true and correct to the best of my knowledge and belief.
7. NAME OF SCHOOL
8. DATE
9A. SIGNATURE OF CLAIMANT, GUARDIAN OR CUSTODIAN
9B. DAYTIME PHONE NO.
9C. EVENING PHONE NO.
(Include Area Code)
(Include Area Code)
PENALTY - The law provides severe penalties which include fine or imprisonment, or both, for the willful submission of any statements or evidence of a material fact, knowing it to be false.
VA FORM 21-674c, FEB 2012
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VA Form 21-674c Instructions

The person eligible to complete the document is the parent, guardian, or custodian of the veteran's child. The applicant is allowed to fill out the form only after reaching the age of majority determined by State laws.

VA Form 21-674c instructions are as follows:

  1. Item 1 is reserved for the address of the VA office the form should be submitted to. If no address is indicated, the document should be sent to the office closest to the applicant's place of residence;
  2. Items 2A and 2B are for the full name and email address of the veteran. The VA file number will be indicated in Item 3;
  3. Items 4 through 6 require entering personal information about the student. This includes their full name, SSN, date of birth, marital status, and address;
  4. Any tuition or allowances paid by the VA DEA, the Federal Employee's Compensation Act or any other government agency or program to the student must be identified in box 7A. Payment details have to be described in box 7B and 7C.;
  5. Boxes 8 through 10 should contain detailed information about the school or the courses for which approval is requested;
  6. If the student was attending any school at the end of the last school term, that should be reflected and described in box 11;
  7. Part II is necessary if the student claims or receives a disability pension or death pension. Otherwise, it should be skipped.

Each line in Part II should be filled in - if the student does not receive income from the specified source enter "0" or "None". Gross amount are calculated as they are prior to the deduction of insurance costs, taxes and other expenses.

  1. Part III contains certification and agreement that should be carefully read and then signed by the claimant. This Part also requires entering daytime and evening phone numbers and describing the claimant's relationship to the student.

The form should be completed in duplicate. The VA file copy is submitted to the VA Office and the claimant's copy is kept by the applicant with other personal paperwork.

VA 21-674c Related Forms

The VA 21-674c has two related forms:

  1. VA Form 21-674, Request For Approval of School Attendance - an electronic version of the VA 21-674c - is submitted to request approval of school attendance and to claim authorized benefit payments.
  2. VA Form 21-674b, School Attendance Report is a document used for confirming school attendance of a veteran's child who receives VA compensation or pension benefits, and for reporting any changes in the status of the student including marriage, termination of school attendance, change of courses, etc.

Both forms can be downloaded as a single document or as separate forms and are hosted on the VA website. The VA 21-674c is originally distributed through the GSA Regulatory Information Service Center website.

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