YUBA COLLEGE VETERAN SERVICES 2088 N. BEALE RD., MARYSVILLE, CA 95901 (530) 741-6822 veteranservices@yccd.edu
YUBA COLLEGE VETERANS SERVICES OFFICE
DECLARATION OF ENROLLMENT
(This form MUST be completed each semester to ensure proper certification)
Name:
Student ID #:
Birth Month:
SSN (Student):
VA File # (Sponsor SSN, if different from student):
Phone #:
Most Frequently Used E-Mail:
Anticipated Graduation Year (Please Estimate):
Lived in California for the last 12 months?
Address: Street City State Zip
VA Education Benefit Chapter Selection
(Check one)
CH 33 (Post-911 GI Bill) ______% CH 33T (Post-911 GI Bill, Transfer of Eligibility)
CH 30 (Montgomery GI Bill) CH 35 (Survivors’ & Dependents)
CH 1606 (Reservists/Guard) CH 1607 (Active Reserve/Guard)
When did you last apply for Promise Grant? Month/Year ___________________
Were you approved for Promise Grant? YES NO
*All students using VA Education Benefits are required to apply for BOG/Promise Grant each year
Select Education Objective
AA/AS/ADT Certificate CSU/IGETC Transfer
Major:
Semester to be Certified with VA
Fall Spring Summer Year: ________
Course Name and Number
(i.e. ENGL-1A, MATH 52)
Ed Plan Area
(i.e. A2 or Critical
Thinking)
End Date
Initials & Date
(Verified By)
YUBA COLLEGE VETERAN SERVICES 2088 N. BEALE RD., MARYSVILLE, CA 95901 (530) 741-6822 veteranservices@yccd.edu
Statements of Understanding
Please read the following statements and initial in the space provided.
_____ I understand that I have met or will meet with a counselor to ensure compliance with my
educational objective. A VA Education Plan must be on file prior to Certification of VA
benefits.
_____ I understand that I must submit THIS Declaration of Enrollment every semester, and that it
takes 4 to 8 weeks for the VA regional Office to process my educational benefits.
_____ I understand that the VA does not pay for recommended courses, challenged courses,
any class that I have not met prerequisite requirements for, or any class that is not part of
my EDUCATIONAL PLAN. Failure to take proper courses will result in an overpayment and
the reduction or possible termination of benefits. Veterans and Dependents assume full
liability for any overpayment of veterans’ benefits.
_____ I have provided, or will provide official transcripts to Yuba College Admissions and
Records Office for all the colleges I have attended. (This includes military training and the
DD-214). Failure to submit official transcripts/DD-214 will cause a delay in benefits.
_____ I will promptly notify the Yuba College Veterans Service Office of any classes that I add,
drop, or stop attending during the semester. Failure to do so may result in overpayment,
which I may be required to refund the VA.
_____ I will notify the Yuba College Veterans Service Office of any changes to my personal
data, such as a name, address, phone, or email change.
_____ If certification is based on my application for benefits, I understand that I must turn in my
certificate of eligibility immediately upon receipt. Without the certificate of eligibility, I
understand that I may not be certified for subsequent semesters.
_____ In order to receive VA benefits, I must maintain Satisfactory Academic Progress. This
means maintaining a cumulative GPA of 2.0. I understand that failure to comply with these
rules may result in termination of my VA educational Benefits.
_____ I understand that non-standard terms (short term classes) are certified individually and
will affect the number of units I am pursuing in the VA system.
_____ I understand that by signing this form, I authorize the release of any and all information
concerning my VA benefits, class schedule, and grade reports (transcripts) to all Yuba
College Veterans Office Staff, VA Personnel and relative contractors.
_____ I understand that all Post 9/11 (Chapter 33/33T) GI Bill users, must take a minimum of 6.5
units per semester to receive benefits. Furthermore, I must take at least one face-to-face
course in order to receive MHA benefits. Otherwise I will receive ½ the National Average.
I hereby certify that I have read, understand, and agree will the above initialed statements.
______________________________________________________ _______________________
Signature Date
(Revised: February 2, 2019)