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OMBRespondentControlBurden:No. 2900-00145 Mins.

AUTHORIZATIONREHABILITATIONAND CERTIFICATIONAND C E R T I F I C A T I O N
AUTHORIZATIONREHABILITATIONAND CERTIFICATIONAND C E R T I F I C A T I O N

AUTHORIZATIONREHABILITATIONAND CERTIFICATIONAND CERTIFICATIONOF ENTRANCEOFORSTATUSREENTRANCE INTO

NOTE: Before completing this form, read the instructions and other important information on the back.

SECTION A - IDENTIFYING DATA

1.

NAME AND MAILING ADDRESS OF ENTITLED INDIVIDUAL

2.

VA FILE NUMBER

.

.

 
 

3.

SOCIAL SECURITY NUMBER

SECTION B - AUTHORIZATION TO FACILITY/VENDOR

4. NAME OF SERVICE/ASSISTANCE (Include degree type when applicable)

5. ENROLLMENT PERIOD

6. PLAN CODE

7. FACILITY CODE

8.

NAME AND ADDRESS OF FACILITY OR SERVICE PROVIDER (Vendor)

 

9. notSPECIFICapproved;GUIDELINESrestricted approved; etc.) bookstore(Restrictedpurchases;hours; tutoringcourses approved/

10.

NAME OF CASE MANAGER OR DESIGNEE AND ADDRESS OF REGIONAL OFFICE

 

.

.

 

11A. SIGNATURE OF CASE MANAGER

11B. DATE SIGNED

SECTION C - CERTIFICATION OF ATTENDANCE

12.ItemI current: CERTIFY13A. (Check He orTHATshe one) continuesthe individualto be inpursuingItem 1 beganor enrolledor resumedin thattheprogram.programChargesshown inforItemthis 4programon the beginningare in

accordancedate for termwith 1ourin

c c o r d a n c e d a t e for termwith 1ourin

VA CONTRACT OR AGREEMENT

d a t e for termwith 1ourin VA CONTRACT OR AGREEMENT SCHOOL CATALOG OTHER PUBLISHED DOCUMENT

SCHOOL CATALOG

for termwith 1ourin VA CONTRACT OR AGREEMENT SCHOOL CATALOG OTHER PUBLISHED DOCUMENT 13. ENROLLMENT DATE B.

OTHER PUBLISHED DOCUMENT

13. ENROLLMENT DATE

B. BEGINNING DATE

1

2

C. ENDING DATE

D.NUMBERTYPE ANDOF

Q=quarterD=deficiencyR=residenceC=clock/shopU=carnegie) (S=semesterD.NUMBERTYPE ANDOF

E. (F=full-time3/4=3/4-time1/2=1/2-timeL=less1/2-time)than TRAINING TIME

A. TERM

3

4

4
TRAINING TIME A. TERM 3 4 F.SESSIONSTANDARDPERCLASSWEEK (Onlytermif non-standard t
F.SESSIONSTANDARDPERCLASSWEEK (Onlytermif non-standard t h e h o u r s t e r m

F.SESSIONSTANDARDPERCLASSWEEK (Onlytermif non-standard thehourstermif lessiscertifiedthanof length)

theor

(Onlytermif non-standard t h e h o u r s t e r m i f
(Onlytermif non-standard t h e h o u r s t e r m i f
(Onlytermif non-standard t h e h o u r s t e r m i f

14. LISTING OF SPECIFIC COURSES (In place of this list, you may attach a copy of registration or other documentation)

15A. SIGNATURE AND TITLE OF CERTIFYING OFFICIAL

15B. DATE SIGNED

VAAPRFORM2002

28-1905

EXISTINGWILL BE USED.STOCKS OF VA FORM 28-1905, SEP 1992,

COPY 1 - CER FOLDER

18,forrehabilitationarrearstuition,titledirectly38,fees,U.S.C.).programtobooks,theUnderforinstitutionandthisChapterssuppliesindividual.all18forvouchersandtheForward31,programforbutvoucherstheNOTidentifiedveteran’sunderforChapterinprogramtuition,Item ThisRehabilitationtitle Chapter Afterpleaseto the 38formU.S.C.);authorizes(Chapteror thecasecompleteveteranmanagerallorapplicableoreligiblepersonpersoninitemsItemhasin10.theenrolledNotecertificationtheseor INSTRUCTIONS 31 or child Vocationalthis31, under Chapter TO titleveteranTraining38, SCHOOL, 18 U.S.C);or should foreligibleCertainSpecializedpersonChildrenVocationalforWithtrainingSpinaTraining,orBifidaservicesSpecialor ON-JOB not pay hasspecialbegunin these TRAINING expenses. Sectioninstructionshis ESTABLISHMENT, orC,hersignforrehabilitationandcompletingdate 35,4.expensesfees,Itemthe booksDepartment9 OtheratRestorativeyourCoveredfacilityBirthTrainingunderDefects(ChapterVocational(Chapter35, liststo thetheorcertification,trainingfollowingprogramitems:and theandspecificofficesupplies.of OR OTHER Veteransguidelinesin ItemTheAffairs10.veteranregardingVAwillpaysunderpaythein FACILITY returnor evaluation,the form Itemterm year,planacademicprojectsincludingyear.attendancesummer ItemFor Item13D other13D.programs,For represents.13E. basis,13A. For Forenterschoolsup each college-levelenter term, to fouror sessionsfor indicate thecoursestype institutionsterms, the entireif the andorganizednumber butprovidingdo appropriate.academic training NOT time ofonclassrooma entertraininga Ifyear,the the term facility theindividualsschool totalor basis,andentershopthehourstypeperandweek.number instructionenrollment considers orvocationalinstitution that onperioda the semester,that rehabilitationshould number exceedsquarter,1 certifyorthetrainingentire of of hours credit academicor in hours. other Item The ForWages,theseon-jobformsor case Itemand classLiaisonsessions,Representative.nonstandard Itemcoursesataking.copy14.ofwhichYouthe manager VAtraining,youFormwill reports13F. may Answertrainingthistimeitemin haveyou28-1917,willto mustindividual’ssupplementcompleteanregistrationon-jobthis also request submit.alsoMonthlyneed that credit-hours.only term you Statementto if lengths, itemor submit the submit facilityFor orforapprenticeothercollege-leveldocumentationtrainingorprogram.vocationalthat ofmonthlyWageseitherPaid and additional aorganizesdetailed term hours, information explanationits toVATrainee.Form classes contact with inofsemesters,the the detailsIntraining.placetheof 28-1905c,The this VA case form. relationshipquarters,betweenor regional managerMonthlywillRecordinformof coursesanThisentry,includestheyouindividualmayclassroomattachis office’s otherstandardterms Education youTrainingwhichandof PRIVACYinformationconsideredauthorized Compensation,informationsubject RESPONDENTof issources,haveestimatedcommentsgatheringto information to verificationis confidential.ACTbyrequestedtheINFORMATION:PrivacyisTheyfurnishedAct,mayincludingbeNoasdisclosedallowancerequiredtheoutsideroutinebyof consideredPension,throughEducationrelevantcomputerandandnecessarymatchingRehabilitationtoprogramsdetermineRecordswithmaximum-otherVA,agencies.publishedbenefits unlessBURDEN:it averageregardingand maintaining5 displaysVA thisminutesburdenpertheestimateresponse,data maya validnotOMBconductControlor needed,or includinganyandothercompletingaspectthe sponsor,Number.andPublicrespondentreportingis benefitsexistingtheusesDepartmentforlawidentifieda timeofandforthisreviewingreviewingcollection veteran(38ofU.S.C.Veteransinortheeligible5101).VAAffairspersonsystemThe(VA)responsesmayofonlyrecords,be notburdenrequiredfor underin instructions,theof thetheFederallaw. information,collectionsearchingofcallinformation.1-800-827-1000existingIf thisto respondcollectionto InformationRegister. grantedif youthe ofthisinformationcollection Thesubmittedrequestedis disclosure58VA21/22,submitunless datayou theareis for mailing information on where to send your comments.

OMBRespondentControlBurden:No. 2900-00145 Mins.

AUTHORIZATIONREHABILITATIONAND CERTIFICATIONAND C E R T I F I C A T I O N
AUTHORIZATIONREHABILITATIONAND CERTIFICATIONAND C E R T I F I C A T I O N

AUTHORIZATIONREHABILITATIONAND CERTIFICATIONAND CERTIFICATIONOF ENTRANCEOFORSTATUSREENTRANCE INTO

NOTE: Before completing this form, read the instructions and other important information on the back.

SECTION A - IDENTIFYING DATA

1.

NAME AND MAILING ADDRESS OF ENTITLED INDIVIDUAL

2.

VA FILE NUMBER

.

.

 
 

3.

SOCIAL SECURITY NUMBER

SECTION B - AUTHORIZATION TO FACILITY/VENDOR

4. NAME OF SERVICE/ASSISTANCE (Include degree type when applicable)

5. ENROLLMENT PERIOD

6. PLAN CODE

7. FACILITY CODE

8.

NAME AND ADDRESS OF FACILITY OR SERVICE PROVIDER (Vendor)

 

9. notSPECIFICapproved;GUIDELINESrestricted approved; etc.) bookstore(Restrictedpurchases;hours; tutoringcourses approved/

10.

NAME OF CASE MANAGER OR DESIGNEE AND ADDRESS OF REGIONAL OFFICE

 

.

.

 

11A. SIGNATURE OF CASE MANAGER

11B. DATE SIGNED

SECTION C - CERTIFICATION OF ATTENDANCE

12.ItemI current: CERTIFY13A. (Check He orTHATshe one) continuesthe individualto be inpursuingItem 1 beganor enrolledor resumedin thattheprogram.programChargesshown inforItemthis 4programon the beginningare in

accordancedate for termwith 1ourin

c c o r d a n c e d a t e for termwith 1ourin

VA CONTRACT OR AGREEMENT

d a t e for termwith 1ourin VA CONTRACT OR AGREEMENT SCHOOL CATALOG OTHER PUBLISHED DOCUMENT

SCHOOL CATALOG

for termwith 1ourin VA CONTRACT OR AGREEMENT SCHOOL CATALOG OTHER PUBLISHED DOCUMENT 13. ENROLLMENT DATE B.

OTHER PUBLISHED DOCUMENT

13. ENROLLMENT DATE

B. BEGINNING DATE

1

2

C. ENDING DATE

D.NUMBERTYPE ANDOF

Q=quarterD=deficiencyR=residenceC=clock/shopU=carnegie) (S=semesterD.NUMBERTYPE ANDOF

E. (F=full-time3/4=3/4-time1/2=1/2-timeL=less1/2-time)than TRAINING TIME

A. TERM

3

4

4
TRAINING TIME A. TERM 3 4 F.SESSIONSTANDARDPERCLASSWEEK (Onlytermif non-standard t
F.SESSIONSTANDARDPERCLASSWEEK (Onlytermif non-standard t h e h o u r s t e r m

F.SESSIONSTANDARDPERCLASSWEEK (Onlytermif non-standard thehourstermif lessiscertifiedthanof length)

theor

(Onlytermif non-standard t h e h o u r s t e r m i f
(Onlytermif non-standard t h e h o u r s t e r m i f
(Onlytermif non-standard t h e h o u r s t e r m i f

14. LISTING OF SPECIFIC COURSES (In place of this list, you may attach a copy of registration or other documentation)

15A. SIGNATURE AND TITLE OF CERTIFYING OFFICIAL

15B. DATE SIGNED

VAAPRFORM2002

28-1905

EXISTINGWILL BE USED.STOCKS OF VA FORM 28-1905, SEP 1992,

COPY 2 - FACILITY

18,forrehabilitationarrearstuition,titledirectly38,fees,U.S.C.).programtobooks,theUnderforinstitutionandthisChapterssuppliesindividual.all18forvouchersandtheForward31,programforbutvoucherstheNOTidentifiedveteran’sunderforChapterinprogramtuition,Item ThisRehabilitationtitle Chapter Afterpleaseto the 38formU.S.C.);authorizes(Chapteror thecasecompleteveteranmanagerallorapplicableoreligiblepersonpersoninitemsItemhasin10.theenrolledNotecertificationtheseor INSTRUCTIONS 31 or child Vocationalthis31, under Chapter TO titleveteranTraining38, SCHOOL, 18 U.S.C);or should foreligibleCertainSpecializedpersonChildrenVocationalforWithtrainingSpinaTraining,orBifidaservicesSpecialor ON-JOB not pay hasspecialbegunin these TRAINING expenses. Sectioninstructionshis ESTABLISHMENT, orC,hersignforrehabilitationandcompletingdate 35,4.expensesfees,Itemthe booksDepartment9 OtheratRestorativeyourCoveredfacilityBirthTrainingunderDefects(ChapterVocational(Chapter35, liststo thetheorcertification,trainingfollowingprogramitems:and theandspecificofficesupplies.of OR OTHER Veteransguidelinesin ItemTheAffairs10.veteranregardingVAwillpaysunderpaythein FACILITY returnor evaluation,the form Itemterm year,planacademicprojectsincludingyear.attendancesummer ItemFor Item13D other13D.programs,For represents.13E. basis,13A. For Forenterschoolsup each college-levelenter term, to fouror sessionsfor indicate thecoursestype institutionsterms, the entireif the andorganizednumber butprovidingdo appropriate.academic training NOT time ofonclassrooma entertraininga Ifyear,the the term facility theindividualsschool totalor basis,andentershopthehourstypeperandweek.number instructionenrollment considers orvocationalinstitution that onperioda the semester,that rehabilitationshould number exceedsquarter,1 certifyorthetrainingentire of of hours credit academicor in hours. other Item The ForWages,theseon-jobformsor case Itemand classLiaisonsessions,Representative.nonstandard Itemcoursesataking.copy14.ofwhichYouthe manager VAtraining,youFormwill reports13F. may Answertrainingthistimeitemin haveyou28-1917,willto mustindividual’ssupplementcompleteanregistrationon-jobthis also request submit.alsoMonthlyneed that credit-hours.only term you Statementto if lengths, itemor submit the submit facilityFor orforapprenticeothercollege-leveldocumentationtrainingorprogram.vocationalthat ofmonthlyWageseitherPaid and additional aorganizesdetailed term hours, information explanationits toVATrainee.Form classes contact with inofsemesters,the the detailsIntraining.placetheof 28-1905c,The this VA case form. relationshipquarters,betweenor regional managerMonthlywillRecordinformof coursesanThisentry,includestheyouindividualmayclassroomattachis office’s otherstandardterms Education youTrainingwhichandof PRIVACYinformationconsideredauthorized Compensation,informationsubject RESPONDENTof issources,haveestimatedcommentsgatheringto information to verificationis confidential.ACTbyrequestedtheINFORMATION:PrivacyisTheyfurnishedAct,mayincludingbeNoasdisclosedallowancerequiredtheoutsideroutinebyof consideredPension,throughEducationrelevantcomputerandandnecessarymatchingRehabilitationtoprogramsdetermineRecordswithmaximum-otherVA,agencies.publishedbenefits unlessBURDEN:it averageregardingand maintaining5 displaysVA thisminutesburdenpertheestimateresponse,data maya validnotOMBconductControlor needed,or includinganyandothercompletingaspectthe sponsor,Number.andPublicrespondentreportingis benefitsexistingtheusesDepartmentforlawidentifieda timeofandforthisreviewingreviewingcollection veteran(38ofU.S.C.Veteransinortheeligible5101).VAAffairspersonsystemThe(VA)responsesmayofonlyrecords,be notburdenrequiredfor underin instructions,theof thetheFederallaw. information,collectionsearchingofcallinformation.1-800-827-1000existingIf thisto respondcollectionto InformationRegister. grantedif youthe ofthisinformationcollection Thesubmittedrequestedis disclosure58VA21/22,submitunless datayou theareis for mailing information on where to send your comments.

OMBRespondentControlBurden:No. 2900-00145 Mins.

AUTHORIZATIONREHABILITATIONAND CERTIFICATIONAND C E R T I F I C A T I O N
AUTHORIZATIONREHABILITATIONAND CERTIFICATIONAND C E R T I F I C A T I O N

AUTHORIZATIONREHABILITATIONAND CERTIFICATIONAND CERTIFICATIONOF ENTRANCEOFORSTATUSREENTRANCE INTO

NOTE: Before completing this form, read the instructions and other important information on the back.

SECTION A - IDENTIFYING DATA

1.

NAME AND MAILING ADDRESS OF ENTITLED INDIVIDUAL

2.

VA FILE NUMBER

.

.

 
 

3.

SOCIAL SECURITY NUMBER

SECTION B - AUTHORIZATION TO FACILITY/VENDOR

4. NAME OF SERVICE/ASSISTANCE (Include degree type when applicable)

5. ENROLLMENT PERIOD

6. PLAN CODE

7. FACILITY CODE

8.

NAME AND ADDRESS OF FACILITY OR SERVICE PROVIDER (Vendor)

 

9. notSPECIFICapproved;GUIDELINESrestricted approved; etc.) bookstore(Restrictedpurchases;hours; tutoringcourses approved/

10.

NAME OF CASE MANAGER OR DESIGNEE AND ADDRESS OF REGIONAL OFFICE

 

.

.

 

11A. SIGNATURE OF CASE MANAGER

11B. DATE SIGNED

SECTION C - CERTIFICATION OF ATTENDANCE

12.ItemI current: CERTIFY13A. (Check He orTHATshe one) continuesthe individualto be inpursuingItem 1 beganor enrolledor resumedin thattheprogram.programChargesshown inforItemthis 4programon the beginningare in

accordancedate for termwith 1ourin

c c o r d a n c e d a t e for termwith 1ourin

VA CONTRACT OR AGREEMENT

d a t e for termwith 1ourin VA CONTRACT OR AGREEMENT SCHOOL CATALOG OTHER PUBLISHED DOCUMENT

SCHOOL CATALOG

for termwith 1ourin VA CONTRACT OR AGREEMENT SCHOOL CATALOG OTHER PUBLISHED DOCUMENT 13. ENROLLMENT DATE B.

OTHER PUBLISHED DOCUMENT

13. ENROLLMENT DATE

B. BEGINNING DATE

1

2

C. ENDING DATE

D.NUMBERTYPE ANDOF

Q=quarterD=deficiencyR=residenceC=clock/shopU=carnegie) (S=semesterD.NUMBERTYPE ANDOF

E. (F=full-time3/4=3/4-time1/2=1/2-timeL=less1/2-time)than TRAINING TIME

A. TERM

3

4

4
TRAINING TIME A. TERM 3 4 F.SESSIONSTANDARDPERCLASSWEEK (Onlytermif non-standard t
F.SESSIONSTANDARDPERCLASSWEEK (Onlytermif non-standard t h e h o u r s t e r m

F.SESSIONSTANDARDPERCLASSWEEK (Onlytermif non-standard thehourstermif lessiscertifiedthanof length)

theor

(Onlytermif non-standard t h e h o u r s t e r m i f
(Onlytermif non-standard t h e h o u r s t e r m i f
(Onlytermif non-standard t h e h o u r s t e r m i f

14. LISTING OF SPECIFIC COURSES (In place of this list, you may attach a copy of registration or other documentation)

15A. SIGNATURE AND TITLE OF CERTIFYING OFFICIAL

15B. DATE SIGNED

VAAPRFORM2002

28-1905

EXISTINGWILL BE USED.STOCKS OF VA FORM 28-1905, SEP 1992,

COPY 3 - INDIVIDUAL

18,forrehabilitationarrearstuition,titledirectly38,fees,U.S.C.).programtobooks,theUnderforinstitutionandthisChapterssuppliesindividual.all18forvouchersandtheForward31,programforbutvoucherstheNOTidentifiedveteran’sunderforChapterinprogramtuition,Item ThisRehabilitationtitle Chapter Afterpleaseto the 38formU.S.C.);authorizes(Chapteror thecasecompleteveteranmanagerallorapplicableoreligiblepersonpersoninitemsItemhasin10.theenrolledNotecertificationtheseor INSTRUCTIONS 31 or child Vocationalthis31, under Chapter TO titleveteranTraining38, SCHOOL, 18 U.S.C);or should foreligibleCertainSpecializedpersonChildrenVocationalforWithtrainingSpinaTraining,orBifidaservicesSpecialor ON-JOB not pay hasspecialbegunin these TRAINING expenses. Sectioninstructionshis ESTABLISHMENT, orC,hersignforrehabilitationandcompletingdate 35,4.expensesfees,Itemthe booksDepartment9 OtheratRestorativeyourCoveredfacilityBirthTrainingunderDefects(ChapterVocational(Chapter35, liststo thetheorcertification,trainingfollowingprogramitems:and theandspecificofficesupplies.of OR OTHER Veteransguidelinesin ItemTheAffairs10.veteranregardingVAwillpaysunderpaythein FACILITY returnor evaluation,the form Itemterm year,planacademicprojectsincludingyear.attendancesummer ItemFor Item13D other13D.programs,For represents.13E. basis,13A. For Forenterschoolsup each college-levelenter term, to fouror sessionsfor indicate thecoursestype institutionsterms, the entireif the andorganizednumber butprovidingdo appropriate.academic training NOT time ofonclassrooma entertraininga Ifyear,the the term facility theindividualsschool totalor basis,andentershopthehourstypeperandweek.number instructionenrollment considers orvocationalinstitution that onperioda the semester,that rehabilitationshould number exceedsquarter,1 certifyorthetrainingentire of of hours credit academicor in hours. other Item The ForWages,theseon-jobformsor case Itemand classLiaisonsessions,Representative.nonstandard Itemcoursesataking.copy14.ofwhichYouthe manager VAtraining,youFormwill reports13F. may Answertrainingthistimeitemin haveyou28-1917,willto mustindividual’ssupplementcompleteanregistrationon-jobthis also request submit.alsoMonthlyneed that credit-hours.only term you Statementto if lengths, itemor submit the submit facilityFor orforapprenticeothercollege-leveldocumentationtrainingorprogram.vocationalthat ofmonthlyWageseitherPaid and additional aorganizesdetailed term hours, information explanationits toVATrainee.Form classes contact with inofsemesters,the the detailsIntraining.placetheof 28-1905c,The this VA case form. relationshipquarters,betweenor regional managerMonthlywillRecordinformof coursesanThisentry,includestheyouindividualmayclassroomattachis office’s otherstandardterms Education youTrainingwhichandof PRIVACYinformationconsideredauthorized Compensation,informationsubject RESPONDENTof issources,haveestimatedcommentsgatheringto information to verificationis confidential.ACTbyrequestedtheINFORMATION:PrivacyisTheyfurnishedAct,mayincludingbeNoasdisclosedallowancerequiredtheoutsideroutinebyof consideredPension,throughEducationrelevantcomputerandandnecessarymatchingRehabilitationtoprogramsdetermineRecordswithmaximum-otherVA,agencies.publishedbenefits unlessBURDEN:it averageregardingand maintaining5 displaysVA thisminutesburdenpertheestimateresponse,data maya validnotOMBconductControlor needed,or includinganyandothercompletingaspectthe sponsor,Number.andPublicrespondentreportingis benefitsexistingtheusesDepartmentforlawidentifieda timeofandforthisreviewingreviewingcollection veteran(38ofU.S.C.Veteransinortheeligible5101).VAAffairspersonsystemThe(VA)responsesmayofonlyrecords,be notburdenrequiredfor underin instructions,theof thetheFederallaw. information,collectionsearchingofcallinformation.1-800-827-1000existingIf thisto respondcollectionto InformationRegister. grantedif youthe ofthisinformationcollection Thesubmittedrequestedis disclosure58VA21/22,submitunless datayou theareis for mailing information on where to send your comments.

OMBRespondentControlBurden:No. 2900-00145 Mins.

AUTHORIZATIONREHABILITATIONAND CERTIFICATIONAND C E R T I F I C A T I O N
AUTHORIZATIONREHABILITATIONAND CERTIFICATIONAND C E R T I F I C A T I O N

AUTHORIZATIONREHABILITATIONAND CERTIFICATIONAND CERTIFICATIONOF ENTRANCEOFORSTATUSREENTRANCE INTO

NOTE: Before completing this form, read the instructions and other important information on the back.

SECTION A - IDENTIFYING DATA

1.

NAME AND MAILING ADDRESS OF ENTITLED INDIVIDUAL

2.

VA FILE NUMBER

.

.

 
 

3.

SOCIAL SECURITY NUMBER

SECTION B - AUTHORIZATION TO FACILITY/VENDOR

4. NAME OF SERVICE/ASSISTANCE (Include degree type when applicable)

5. ENROLLMENT PERIOD

6. PLAN CODE

7. FACILITY CODE

8.

NAME AND ADDRESS OF FACILITY OR SERVICE PROVIDER (Vendor)

 

9. notSPECIFICapproved;GUIDELINESrestricted approved; etc.) bookstore(Restrictedpurchases;hours; tutoringcourses approved/

10.

NAME OF CASE MANAGER OR DESIGNEE AND ADDRESS OF REGIONAL OFFICE

 

.

.

 

11A. SIGNATURE OF CASE MANAGER

11B. DATE SIGNED

SECTION C - CERTIFICATION OF ATTENDANCE

12.ItemI current: CERTIFY13A. (Check He orTHATshe one) continuesthe individualto be inpursuingItem 1 beganor enrolledor resumedin thattheprogram.programChargesshown inforItemthis 4programon the beginningare in

accordancedate for termwith 1ourin

c c o r d a n c e d a t e for termwith 1ourin

VA CONTRACT OR AGREEMENT

d a t e for termwith 1ourin VA CONTRACT OR AGREEMENT SCHOOL CATALOG OTHER PUBLISHED DOCUMENT

SCHOOL CATALOG

for termwith 1ourin VA CONTRACT OR AGREEMENT SCHOOL CATALOG OTHER PUBLISHED DOCUMENT 13. ENROLLMENT DATE B.

OTHER PUBLISHED DOCUMENT

13. ENROLLMENT DATE

B. BEGINNING DATE

1

2

C. ENDING DATE

D.NUMBERTYPE ANDOF

Q=quarterD=deficiencyR=residenceC=clock/shopU=carnegie) (S=semesterD.NUMBERTYPE ANDOF

E. (F=full-time3/4=3/4-time1/2=1/2-timeL=less1/2-time)than TRAINING TIME

A. TERM

3

4

4
TRAINING TIME A. TERM 3 4 F.SESSIONSTANDARDPERCLASSWEEK (Onlytermif non-standard t
F.SESSIONSTANDARDPERCLASSWEEK (Onlytermif non-standard t h e h o u r s t e r m

F.SESSIONSTANDARDPERCLASSWEEK (Onlytermif non-standard thehourstermif lessiscertifiedthanof length)

theor

(Onlytermif non-standard t h e h o u r s t e r m i f
(Onlytermif non-standard t h e h o u r s t e r m i f
(Onlytermif non-standard t h e h o u r s t e r m i f

14. LISTING OF SPECIFIC COURSES (In place of this list, you may attach a copy of registration or other documentation)

15A. SIGNATURE AND TITLE OF CERTIFYING OFFICIAL

15B. DATE SIGNED

VAAPRFORM2002

28-1905

EXISTINGWILL BE USED.STOCKS OF VA FORM 28-1905, SEP 1992,

COPY 4 - CONTROL

18,forrehabilitationarrearstuition,titledirectly38,fees,U.S.C.).programtobooks,theUnderforinstitutionandthisChapterssuppliesindividual.all18forvouchersandtheForward31,programforbutvoucherstheNOTidentifiedveteran’sunderforChapterinprogramtuition,Item ThisRehabilitationtitle Chapter Afterpleaseto the 38formU.S.C.);authorizes(Chapteror thecasecompleteveteranmanagerallorapplicableoreligiblepersonpersoninitemsItemhasin10.theenrolledNotecertificationtheseor INSTRUCTIONS 31 or child Vocationalthis31, under Chapter TO titleveteranTraining38, SCHOOL, 18 U.S.C);or should foreligibleCertainSpecializedpersonChildrenVocationalforWithtrainingSpinaTraining,orBifidaservicesSpecialor ON-JOB not pay hasspecialbegunin these TRAINING expenses. Sectioninstructionshis ESTABLISHMENT, orC,hersignforrehabilitationandcompletingdate 35,4.expensesfees,Itemthe booksDepartment9 OtheratRestorativeyourCoveredfacilityBirthTrainingunderDefects(ChapterVocational(Chapter35, liststo thetheorcertification,trainingfollowingprogramitems:and theandspecificofficesupplies.of OR OTHER Veteransguidelinesin ItemTheAffairs10.veteranregardingVAwillpaysunderpaythein FACILITY returnor evaluation,the form Itemterm year,planacademicprojectsincludingyear.attendancesummer ItemFor Item13D other13D.programs,For represents.13E. basis,13A. For Forenterschoolsup each college-levelenter term, to fouror sessionsfor indicate thecoursestype institutionsterms, the entireif the andorganizednumber butprovidingdo appropriate.academic training NOT time ofonclassrooma entertraininga Ifyear,the the term facility theindividualsschool totalor basis,andentershopthehourstypeperandweek.number instructionenrollment considers orvocationalinstitution that onperioda the semester,that rehabilitationshould number exceedsquarter,1 certifyorthetrainingentire of of hours credit academicor in hours. other Item The ForWages,theseon-jobformsor case Itemand classLiaisonsessions,Representative.nonstandard Itemcoursesataking.copy14.ofwhichYouthe manager VAtraining,youFormwill reports13F. may Answertrainingthistimeitemin haveyou28-1917,willto mustindividual’ssupplementcompleteanregistrationon-jobthis also request submit.alsoMonthlyneed that credit-hours.only term you Statementto if lengths, itemor submit the submit facilityFor orforapprenticeothercollege-leveldocumentationtrainingorprogram.vocationalthat ofmonthlyWageseitherPaid and additional aorganizesdetailed term hours, information explanationits toVATrainee.Form classes contact with inofsemesters,the the detailsIntraining.placetheof 28-1905c,The this VA case form. relationshipquarters,betweenor regional managerMonthlywillRecordinformof coursesanThisentry,includestheyouindividualmayclassroomattachis office’s otherstandardterms Education youTrainingwhichandof PRIVACYinformationconsideredauthorized Compensation,informationsubject RESPONDENTof issources,haveestimatedcommentsgatheringto information to verificationis confidential.ACTbyrequestedtheINFORMATION:PrivacyisTheyfurnishedAct,mayincludingbeNoasdisclosedallowancerequiredtheoutsideroutinebyof consideredPension,throughEducationrelevantcomputerandandnecessarymatchingRehabilitationtoprogramsdetermineRecordswithmaximum-otherVA,agencies.publishedbenefits unlessBURDEN:it averageregardingand maintaining5 displaysVA thisminutesburdenpertheestimateresponse,data maya validnotOMBconductControlor needed,or includinganyandothercompletingaspectthe sponsor,Number.andPublicrespondentreportingis benefitsexistingtheusesDepartmentforlawidentifieda timeofandforthisreviewingreviewingcollection veteran(38ofU.S.C.Veteransinortheeligible5101).VAAffairspersonsystemThe(VA)responsesmayofonlyrecords,be notburdenrequiredfor underin instructions,theof thetheFederallaw. information,collectionsearchingofcallinformation.1-800-827-1000existingIf thisto respondcollectionto InformationRegister. grantedif youthe ofthisinformationcollection Thesubmittedrequestedis disclosure58VA21/22,submitunless datayou theareis for mailing information on where to send your comments.