VA Certification Request Form – Great Bay Community College-冰球突破豪华版试玩

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*You must complete this form for every semester you want your enrollment certified.*
Name*
Student ID#
Address
Street Address City State ZIP Code
Email Address*
Phone
Check:
- Ch33
- Ch30
- Ch1606
- Ch1607
- Ch31
- Ch35
Officially accepted to a degree/certificate program?
- Yes
- No
If YES, Program is
Changed Major? If so, complete VA Form 22-1995.
- Yes
- No
If YES, Program is
Guest student at GBCC?
- Yes
- No
If YES, Home institution is
Currently on Active Duty?
- Yes
- No
If YES, with
Other funding/scholarships for tuition/fees?
- Yes
- No
If YES, from
Please certify me for the following courses:
Semester*
Year*

Start Date	End Date	Course Number/Title	#Credits

- Financial Obligation Statement: I agree that by registering for courses within the Community College System of New Hampshire (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 ANY changes which occur in the information furnished in this form or leave GBCC, for any reason (this includes graduation), I will notify the school IN WRITING. I accept personal liability for any overpayment made to me by VA which results from my Failure to comply with GBCC policies and procedures, or VA regulations, 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 College Catalog and Student Handbook, both accessible at gf.gregorybgallagher.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, National Guard, or funding agency. 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, National Guard, or funding agency to include: Social Security number, address, grades, academic information and rate of academic progress. I have read the above statements, I understand them and my signature signifies my agreement.
Signature
Date
MM slash DD slash YYYY
The Community College System of New Hampshire (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 and 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, financial aid, payment plan, student account, transcript information, 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.
IMPORTANT NOTES: 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.)