YUBA COLLEGE VETERAN SERVICES 2088 N. BEALE RD., MARYSVILLE, CA 95901 (530) 741-6822
(Revised: Mar 2020)
YUBA COLLEGE VETERANS SERVICES OFFICE
DECLARATION OF ENROLLMENT FOR CH 31
(This form MUST be completed each semester to ensure proper certification)
Name:
Student ID #:
Birthday (Month ONLY, not mandatory)
SSN (Student):
Anticipated Graduation Year:
Phone Number:
E-Mail:
CURRENT Address: Street City, State Zip
VA Education Benefit
VR&E Case Manager Name & Contact Information:
Authorization Number & Approved Semesters - Office Use Only
(i.e. FA20 FA21)
:
Financial Aid
When did you last apply for FAFSA/BOG? (ALL VA students PLEASE apply) MONTH/YEAR __________
Were you approved for California Promise Grant (to cover Tuition & Fees)? YES NO
Educational Objective
AA/AS Transfer Degree Certificate
Major Listed on Current Education Plan: __________________________________________
Semester
Fall Spring Summer Year: ________
Course Name and Number
(i.e. ENGL-1A, MATH 52)
Ed Plan Area Fulfilled
(i.e. Area A, Area B, Major,
Etc..)
Start Date
End Date
Signature & Date
(Verified By VA
Employee)
YUBA COLLEGE VETERAN SERVICES 2088 N. BEALE RD., MARYSVILLE, CA 95901 (530) 741-6822
(Revised:
Mar 2020)
Statements of Understanding
Please read the following statements and initial in the space provided.
_____ I understand that I have met with a VR&E counselor to ensure compliance with my educational
objective. A Tungsten Authorization Number (previously known as 28-1905) must be on file prior
to Certification of VA benefits. The VR&E counselor authorized tuition, required fees, required
textbooks and for the classes listed on the previous page
_____ 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 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 failure to comply with these rules may result in termination of my VA educational
Benefits.
I hereby certify that all statements are true and complete to the best of my knowledge.
______________________________________________________ _________________________
Signature Date