SCHOOL ATTENDANCE REPORT

SECTION I: VETERAN/CLAIMANT'S IDENTIFICATION INFORMATION
NOTE: You may complete the form online or by hand. If completed by hand, print the information requested in ink, neatly and legibly, insert one letter
per box, and completely fill in each applicable circle to help expedite processing of the form

VA FILE NUMBER (If applicable)

E-MAIL ADDRESS (Optional)

SECTION II: STUDENT'S IDENTIFICATION INFORMATION
NOTE: If you would like to submit an additional student's information, use a separate form (VA Form 21-674b) for each student.

Social Security Number

HAS STUDENT MARRIED?
later
Yes
No

Date of Marriage (MM/DD/YYYY)

SECTION III: VERIFICATION OF SCHOOL ATTENDANCE
(To be completed by CLAIMANT)
DID STUDENT START THE COURSE OF TRAINING?

later
Yes
No

OFFICIAL BEGINNING DATE OF REGULAR TERM OR COURSE (MM/DD/YYYY)

DATE STUDENT STARTED COURSE OF TRAINING (MM/DD/YYYY)

IS TUITION AND/OR ALLOWANCE FOR STUDENT'S EDUCATION OR TRAINING BEING PAID UNDER DEA, THE FEDERAL EMPLOYEE'S COMPENSATION ACT, OR ANY OTHER FEDERAL AGENCY OR PROGRAM OF THE UNITED STATES GOVERNMENT?

later
Yes
No

TYPE OF BENEFIT (i.e. GI Bill, Fry Scholarship, etc.)

DATE PAYMENTS BEGAN (MM/DD/YYYY)

SECTION IV: CERTIFICATION AND SIGNATURE OF STUDENT

DATE SIGNED (MM/DD/YYYY)

RELATIONSHIP TO STUDENT

Telephone Phone Number

International Telephone Number (If Applicable)


SECTION V: VERIFICATION OF TERMINATION OF SCHOOL ATTENDANCE
(To be completed by SCHOOL)

DATE SCHOOL ATTENDANCE TERMINATED (MM/DD/YYYY)

IS THIS THE OFFICIAL ENDING DATE OF REGULAR TERM FOR SUCH COURSE?

later
Yes
No

BEGINNING DATE OF THE NEXT REGULAR TERM FOLLOWING THE DATE STUDENT DISCONTINUED SCHOOL (MM/DD/YYYY)

OFFICIAL ENDING DATE OF REGULAR TERM (MM/DD/YYYY)

REASON FOR TERMINATION OF SCHOOL ATTENDANCE (If additional space is needed, use Section VII: Remarks)


SECTION VI: CERTIFICATION AND SIGNATURE OF SCHOOL OFFICIAL

DATE SIGNED (MM/DD/YYYY)

TITLE OF SCHOOL OFFICIAL


SECTION VII: REMARKS
(This section can be used by either the claimant or the school

REMARKS (If any)