VA Form 22-5495 Dependents' Request for Change of Program or Place of Training

What Is VA Form 22-5495?

VA Form 22-5495, Dependents' Request for Change of Program or Place of Training is a form used to request a change of program or place of training under two benefit programs: Survivors' and Dependents' Educational Assistance Program and Post-9/11 GI Bill Marine Gunnery Sergeant John David Fry Scholarship.

The form was released by the Department of Veterans Affairs (VA) in December 2016. There is a new version of this form updated by the VA in September 2018 available at this link. However, if you need to download a fillable VA Form 22-5495 for your reference, you can find it below.

To be considered eligible for the VA educational benefits, the applicant should be a spouse or a child of a veteran or a service member, who meets at least one of the following conditions:

  • They are permanently and totally disabled from service-connected causes;
  • They are on active duty and are likely to be discharged with a permanent and total disability;
  • They died while in service;
  • They died of service-connected causes;
  • They are currently missing in action or captured in the line of duty.

This form is related to the VA Form 22-5490, Dependents' Application for VA Education Benefits. It is completed by veterans' spouses, dependents, and survivors in connection with various VA educational benefits programs that offer assistance with covering the cost of tuition, housing, books, and supplies. Education benefits may be used toward a traditional degree, non-college degree, on-the-job training, apprenticeships, and more.


Download VA Form 22-5495 Dependents' Request for Change of Program or Place of Training

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Instructions for VA Form 22-5495

VA Form 22-5495 is distributed with information and filling guidelines provided on the fourth page of the form. The instructions for completing the form can be found below.

How to Fill out VA Form 22-5495?

The form - also known as the VA Benefits Form 22-5495 - consists of five parts in total:

  1. Part I. Applicant Information. Provide your full name, social security number, VA file number, gender, date of birth, current mailing address, phone number(s), and email address. This part also requires your direct deposit information and name, address and phone number of your emergency contact.
  2. Part II. Qualifying Individual Information. This section contains information about the person, on whose account the benefits are being claimed. This includes their full name, social security number or VA file number, a branch of service, date of birth, date of death or date listed as MIA or POW, applicant's relationship to qualifying the individual. An applicant must state if the qualifying individual is currently on active duty or if they or the applicant has an outstanding felony or warrant.
  3. Part III. Applicant's Military Service information. If you have ever served on active duty in the Armed Forces, enter information about your periods of active service, branch of service or reserve or guard component, and character of discharge.
  4. Part IV. Benefit and Type of Education or Training. Fill out this section by providing information on educational benefits. Enter the type of benefit, type of training, education or career objective, the name of the program you request to pursue, name and complete address of old, current, and new school or training establishment, reasons why training at the old or current school or training establishment stopped or will stop.
  5. Part V. Remarks and Certification. This section provides for additional commentary and remarks and certification that all statements in the application are true and correct to the best of the applicant's knowledge and belief.

How to Submit VA Form 22-5495 Online?

VA Form 22-5495 can be completed digitally and submitted online through VA's GI Bill Benefits website.