VA Certification Request Form

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  • *You must complete this form for every semester you want your enrollment certified.*
  • Please certify me for the following courses:
  • 开始日期结束日期课程数量/标题#学分 
    • Financial Obligation 状态ment: I agree that by registering for courses within the Community College System of 新汉普郡 (CCSNH), I am financially obligated for ALL costs related to the registered course(s). Upon a drop or withdrawal, I agree that I will be responsible for all charges as noted in the student catalog and handbook. I further understand that if I do not make payment in full, my account may be reported to the credit bureau and/or turned over to an outside collection agency. I also agree to pay for the fees of any collection agency, which may be based on a percentage of the debt up to a maximum of 35%, and all additional costs and expenses, including any protested check fees, court filing costs and reasonable attorney’s fees, which will add significant costs to my account balance.
    • I agree that if I withdraw from my classes, if there are 任何 changes which occur in the information furnished in this form or leave GBCC, for any reason (this includes graduation), 我会通知学校的 以书面形式. I accept personal liability for any overpayment made to me by VA which results from my Failure to comply with GBCC policies and procedures, 或VA法规, and agree to refund such overpayment promptly to the VA or GBCC
    • I understand GBCC policy on satisfactory progress and GBCC procedures for adding, dropping and withdrawal from school. I agree to comply with the GBCC 大学目录 and 学生手册, both accessible at fgix.0662hao.com. I also know that I can ask the One Stop how to access the policies and I have the right to attend Orientation.
  • I authorize the information furnished on this form to be released to the VA, 国民警卫队, 或者是资助机构. I authorize GBCC to submit to the VA, any changes that may occur which affect my benefit payments and to share academic information as requested by the VA on my behalf. I further agree that GBCC may share my information with the VA, 国民警卫队, 或者是资助机构 to include: Social Security number, address, 成绩, academic information and rate of academic progress. I have read the above statements, I understand them and my signature signifies my agreement.
  • MM / DD / YYYY

  • The Community College System of 新汉普郡 (CCSNH) uses electronic signatures and records in place of traditional ones whenever possible. You will conduct business electronically using a computer with a supported operating system and internet browser, sufficient electronic storage capacity, a printer and your official CCSNH email account. By logging into CCSNH systems, including but not limited to Banner, SIS和Canvas, you are opting to conduct electronic transactions with the Community College System and consenting to receive written notices electronically, including those involving financial obligations, and you are acknowledging that CCSNH can use electronic mechanisms alone to convey critical information related to your admission, 金融援助, 付款计划, 学生账户, 记录信息, registration and other activities and accounts you may undertake or have as a student at CCSNH. You have a right to request a paper copy of an electronic record. You may withdraw your consent at any time by contacting Student Services. If you decide to withdraw your consent, however, you may be prevented from registering for classes.

    重要提示: If you are ordered to active duty or deployed, please notify GBCC in writing ASAP. Also, if you change your major or increase/decrease your credit hours, please notify GBCC in writing ASAP (Notifying through the VA by yourself on the WAVE alone is not sufficient for the VA, as GBCC must re-certify your enrollment as well.)