Please note this form must be completed each semester of enrollment at GCC Name(Required) First Last Email(Required) Enter Email Confirm Email Student ID(Required)Current Term(Required) Spring Summer Fall Are you graduating this term?(Required) Yes No Major(Required)Please chooseAddiction Studies Certificate (ASC) CERTAdventure Education (ADE) ASAllied Health (ALH) ASAllied Health/Dental Assisting Intent (ALH) ASAllied Health/Kinesiology Transfer Intent (ALH) ASAllied Health/LPN Intent (ALH) ASAllied Health/Nutrition Transfer Intent (ALH) ASAllied Health/PMC Intent (ALH) ASAllied Health/Physical Therapy Assistant Intent (ALH) ASAllied Health/Public Health Transfer Intent (ALH) ASAllied Health/Radiologic Technology Intent (ALH) ASAllied Health/Respiratory Therapy Intent (ALH) ASAllied Health/RN Intent (ALH) ASAllied Health/SGT (ALH) ASArt/Visual Art Transfer Block (AVC) ASArt/Visual Arts (AVA) ASBiology (BIO) ASBusiness Administration General (BAG) ASBusiness Administration Transfer (BAT) AAChemistry (CHE) ASComputer Science (CSC) ASEarly Childhood Education (ECE) ASEarly Childhood Education Certificate (CECE) CERTEngineering Science (EGS) ASEnvironmental Conservation (ENC) ASFarm and Food Systems (LFF) AAFire Science Technology (FST) ASHuman Services (HSE) ASJustice Studies (JUS) ASLiberal Arts (LIB) AALiberal Arts/Contemporary Music Studies (LCMS) AALiberal Arts/Education (LEO) AALiberal Arts/English (LAE) AALiberal Arts/Farm and Food Systems (LFF) AALiberal Arts/History (LHI) AALiberal Arts/Mathematics (LMA) AALiberal Arts/Social Sciences (LSS) AALiberal Arts/Theater (LAT) AAManagement Certificate (MGT) CERTMedical Assistant Certificate (MAC) CERTMusic Recording and Production Certificate (MRP) CERTOutdoor Leadership Certificate (OLP) CERTPre-Nursing (NUC) CERTPre-Nursing/ADN Intent (NUC) CERTPre-Nursing/LPN Intent (NUC) CERTPre-Nursing/Nursing Bridge Intent (NUC) CERT ** ONLY AVAILABLE FOR PRACTICAL NURSES **Visual Arts Certificate (VAC) CERTWeb Development & Design Certificate (WDD) CERTWorld Language in French (WFR) CERTWorld Language in Spanish (WSP) CERTStatus(Required)Check all that apply Returning GCC student First time using VA education benefits Used VA benefits at another institution Program Change(Required)Have you changed your degree program since the last semester you attended? No Yes Benefits(Required)What VA or Commonwealth educational benefits do you plan to use? DD Form 214 must be submitted to your SCO. Mass. Categorical Veteran Tuition & Fee Waiver Mass. National Guard Certificate of Eligibility (COE) Chapter 30 Montgomery GI Bill (MGIB) Chapter 31 Veteran Readiness & Employment (VR&E) Chapter 33 Post 9/11 GI Bill Chapter 35 Dependents Educational Assistance (DEA) Chapter 1606 Montgomery GI Bill Selective Reserve (MGIB-SR) Not sure, connect me to an advisor Other Remedial Courses(Required)Are you registered for any remedial courses? The VA will not cover online-only remedial courses. The VA will only accept in-person or hybrid remedial courses. Math English Not registered for any remedial courses Credit Hours(Required)How many credits are you taking this term? You must register for a minimum of five (5) credits to qualify for chapter benefits and 12 credits in-person to qualify for 100% BAH (MHA). Each online credit class will lower your BAH (MHA). All changes made to registration after the add/drop period must be reported to the Veteran Service Advisor immediately. Clinical Hours(Required)Will you have clinical (clocked) hours this term? Yes No Course(Required)Provide name and course numberFinancial Aid(Required)Have you applied for financial aid? E.g., FAFSA, Pell Grant, free community college, etc. Yes No Health Insurance(Required)All students taking a minimum of nine (9) credits must carry health insurance. I'm covered by GCC student health insurance I have waived GCC student health insurance and am covered by a comparable policy Repeat Coursework(Required)Classes that are successfully completed may not be certified again for VA purposes if they are repeated. However, if a student fails a class, or if a program requires a higher grade than the one achieved in a particular class for successful completion, that class may be repeated and certified to the VA again. I am not registered for any courses that I have successfully completed in a previous semester I am registered for a repeat class that I failed previously, or my program requires a higher grade than previously earned Acknowledgement & Consent(Required)I understand that dropping or withdrawing from classes could result in an overpayment of benefits and that I will be required to repay that debt. I understand that I am responsible for any balance on my GCC student account not paid by the Dept. of Veterans Affairs. I understand I have to submit my COE or DD214 in order to be able to use my VA educational benefits. I understand I have to submit a Categorical Tuition Waiver and GI certification each semester to my SCO. I acknowledge and consent to the above terms