NAME (Last, First, Middle Initial)
SSN
PRESEPARATION COUNSELING CHECKLIST
SECTION IV (Continued)
SERVICE MEMBER
SPOUSE
REFERRED TO
(Input is optional)
NO
N/A
YES
NO
N/A
YES
14. EDUCATION/TRAINING
a. Education benefits (Montgomery GI Bill, Veterans Educational
Assistance Program, Vietnam-era, etc.)
b. Job Training Partnership Act (JTPA)
c. Additional education or training options
15. HEALTH AND LIFE INSURANCE
a. 60-day or 120-day extended Military and limited Dental benefits
(VSI, SSB, Eligible Involuntary Separatees)
b. Option to purchase 18-month conversion health insurance.
Concurrent pre-existing condition coverage with purchase of
conversion health insurance.
c.
Veterans' Group Life Insurance
16.
FINANCES
a.
Financial Management
b.
Separation pay (VSI, SSB, Eligible Involuntary Separatees Only)
c.
Unemployment compensation
d. Other financial assistance (VA Loans, SBA Loans, and other
government grants and loans)
17.
RESERVE AFFILIATION/PRIORITY
18.
DISABLED VETERANS BENEFITS
a.
Disabled Transition Assistance Program (DTAP)
b.
VA Disability Benefits
As a separating Service member, after receiving basic preseparation information and completing this checklist, you and your spouse (if
applicable) are entitled to receive assistance in developing an ITP and counseling based on the areas of interest you have identified on the
checklist. The preseparation checklist addresses a variety of transition services and benefits to which you may be entitled. Each individual
is strongly encouraged to take advantage of the opportunity to develop an ITP. The purpose of an ITP is to identify educational, training and
employment objectives and to develop a plan to achieve these objectives. It is the Military Department's responsibility to offer Service
members the opportunity and assistance to develop an ITP. It is the Service member's responsibility to develop an ITP based on his/her
specific objectives and the objectives of his or her spouse, if appropriate.
SECTION V - REMARKS
DD FORM 2648 (BACK), NOV 1999
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