Va Benefit Coding Request Form
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1VA Benefit Coding Request
STUDENT ID
LAST NAME
FIRST NAME
Fall
Semester: ________ Year: ________
Benefit Utilizing (Check One):
Chapter 33: Post 9/11 GI Bill
Chapter 35: Dependent Education Assistance
Chapter 33D: Post 9/11 GI Bill (Dependent)
Chapter 1606: Montgomery GI Bill – Selected Reserves
Chapter 30: Montgomery GI Bill
Chapter 1607: Reserve Education Assistance Program
Chapter 31: Vocational Rehabilitation
This is your indication that, to the best of your knowledge, you are eligible for the above benefit and that you intend
to use the benefit for this semester. If you decide to not use this benefit for this term, it is your responsibility to
notify the Veterans Office. If you do not use the benefit, you will be subject to the decoding of your account.
Please read and initial the following:
______ Your enrollment fees are due when you register in classes. Depending on when you enroll in classes, you may
be dropped within 10 days of your registration if fees are not paid for all benefits EXCEPT students using Post
9/11 GI Bill benefits and Vocational Rehabilitation (HOWEVER without this coding and completing this form
you will be dropped 10 days after enrolling in classes if fees are not paid).
______ Once I have used my VA Education benefits, if I do not certify for two semesters it will result in the
deactivation of my coding. This means your enrollment fees are due when you register in classes. Depending
on when you enroll in classes, you may be dropped within 10 days of your registration if fees are not paid. To
reestablish my coding I will need to fill this request out again with the Palomar Veterans Services Office.
______ I will be responsible for paying Palomar College for any and all tuition and fees not covered by my VA
education benefits (to include out of state tuition and fees). Failure to do so may result in enrollment
blocking, inability to request official transcripts, and eventually my balance could be transferred to
collections. In addition, if I have any past due tuition and or fees, I will be unable to request future VA
certifications at Palomar College.
______ I understand this request does not start my file for VA education benefits. This form is only to activate my
coding as a recipient of VA benefits at Palomar College. To start my benefits, I must complete the New
Student Checklist provided by Palomar College VSO as well as additional paperwork required at the time of
certification.
Signature: _______________________________________
Date: _____________________
Phone #:________________________________________
Received by
Initial
Date
Certifying
Initial
Date
VSO
Official
For the typed signature to be official, this MUST be emailed from your Palomar Student e-mail account.
When completed, save the file with your last name and student ID as the name (e.g. smith123456789) and
email to veterans@palomar.edu with "coding request" in the subject line.
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