Polk State College Veteran'S Deferment Request Form


Student Financial Services
Fall _______ Spring ________ Summer _______
1. ______ / _______ / _______
2. __________________________________________
Polk State Student ID Number
Name (Last, First, M.I.)
3. Mailing Address (Including City, State, Zip)
4. Phone Number: _______________________ 5. Polk State Email Address: ______________________
I certify that I am a veteran or a dependent eligible for one of the following chapters and request that my tuition
and fees be deferred. (Please note, this form is not acceptable if a V.A. benefit chapter has not been selected.)
Chapter 30: Montgomery G.I. Bill ___
Chapter 31: Voc. Rehabilitation & Employment ___
Chapter 32: Veterans Educational Assistance. Program ___
Chapter 33: Post 9/11 G.I. Bill ___
Chapter 35: Dependents’ Educational Assistance. ___
Chapter 1606: Montgomery G.I. Bill ___
Chapter 1607: REAP ___
Submit this form to:
Polk State College Student Financial Services
Veterans Services
999 Avenue H. Northeast
Winter Haven, FL 33881-4299
Phone: 863-297-1004
Fax: (863) 298-6850
Florida Statute 1009.27(2) states any veteran or other eligible student who receives benefits under
chapter 30, chapter 31, chapter 32, chapter 33, chapter 34, or chapter 35 of Title 38, U.S.C., or chapter
106 of Title 10, U.S.C., is entitled to one deferment each academic year and an additional deferment
each time there is a delay in the receipt of benefits.
Polk State College is committed to and encourages equal opportunity/equity/access for its programs, services, and activities.


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