{"id":1137,"date":"2026-04-13T10:40:46","date_gmt":"2026-04-13T14:40:46","guid":{"rendered":"https:\/\/www.gcc.mass.edu\/xvets\/?page_id=1137"},"modified":"2026-06-09T07:33:26","modified_gmt":"2026-06-09T11:33:26","slug":"intake","status":"publish","type":"page","link":"https:\/\/www.gcc.mass.edu\/veterans\/intake\/","title":{"rendered":"Veteran Intake Form"},"content":{"rendered":"<script type=\"text\/javascript\">\n\/* <![CDATA[ *\/\n\n\/\/----------------------------------------------------------\n\/\/------ JAVASCRIPT HOOK FUNCTIONS FOR GRAVITY FORMS -------\n\/\/----------------------------------------------------------\n\nif ( ! gform ) {\n\tdocument.addEventListener( 'gform_main_scripts_loaded', function() { gform.scriptsLoaded = true; } );\n\tdocument.addEventListener( 'gform\/theme\/scripts_loaded', function() { gform.themeScriptsLoaded = true; } );\n\twindow.addEventListener( 'DOMContentLoaded', function() { gform.domLoaded = true; } );\n\n\tvar gform = {\n\t\tdomLoaded: 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class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(Required)<\/span><\/span><\/legend><div class='ginput_complex ginput_container ginput_container--name no_prefix has_first_name no_middle_name has_last_name no_suffix gf_name_has_2 ginput_container_name gform-grid-row' id='input_1_1'>\n                            \n                            <span id='input_1_1_3_container' class='name_first gform-grid-col gform-grid-col--size-auto' >\n                                                    <input type='text' name='input_1.3' id='input_1_1_3' value='' tabindex='1001'  aria-required='true'     \/>\n                                                    <label for='input_1_1_3' class='gform-field-label gform-field-label--type-sub '>First<\/label>\n                                                <\/span>\n                            \n                            <span id='input_1_1_6_container' class='name_last gform-grid-col gform-grid-col--size-auto' >\n                                                    <input type='text' name='input_1.6' id='input_1_1_6' value='' tabindex='1003'  aria-required='true'     \/>\n                                                    <label for='input_1_1_6' class='gform-field-label gform-field-label--type-sub '>Last<\/label>\n                                                <\/span>\n                            \n                        <\/div><\/fieldset><fieldset id=\"field_1_3\" class=\"gfield gfield--type-email gfield--input-type-email gfield--width-half gfield_contains_required field_sublabel_below gfield--no-description field_description_above field_validation_below gfield_visibility_visible\"  ><legend class='gfield_label gform-field-label gfield_label_before_complex' ><span class='gform-field-label__text'>Email<\/span><span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(Required)<\/span><\/span><\/legend><div class='ginput_complex ginput_container ginput_container_email gform-grid-row' id='input_1_3_container'>\n                                <span id='input_1_3_1_container' class='ginput_left gform-grid-col gform-grid-col--size-auto'>\n                                    <input class='' type='email' name='input_3' id='input_1_3' value='' tabindex='1005'   aria-required=\"true\" aria-invalid=\"false\"  \/>\n                                    <label for='input_1_3' class='gform-field-label gform-field-label--type-sub '>Enter Email<\/label>\n                                <\/span>\n                                <span id='input_1_3_2_container' class='ginput_right gform-grid-col gform-grid-col--size-auto'>\n                                    <input class='' type='email' name='input_3_2' id='input_1_3_2' value='' tabindex='1006'   aria-required=\"true\" aria-invalid=\"false\"  \/>\n                                    <label for='input_1_3_2' class='gform-field-label gform-field-label--type-sub '>Confirm Email<\/label>\n                                <\/span>\n                                <div class='gf_clear gf_clear_complex'><\/div>\n                            <\/div><\/fieldset><div id=\"field_1_4\" class=\"gfield gfield--type-text gfield--input-type-text gfield--width-half gfield_contains_required field_sublabel_below gfield--no-description field_description_above field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_1_4'><span class='gform-field-label__text'>Student ID<\/span><span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(Required)<\/span><\/span><\/label><div class='ginput_container ginput_container_text'><input name='input_4' id='input_1_4' type='text' value='' class='large'   tabindex='1007'  aria-required=\"true\" aria-invalid=\"false\"   \/><\/div><\/div><fieldset id=\"field_1_5\" class=\"gfield gfield--type-radio gfield--type-choice gfield--input-type-radio gfield--width-half gf_list_inline gfield_contains_required field_sublabel_below gfield--no-description field_description_above field_validation_below gfield_visibility_visible gfield--choice-align-vertical\"  ><legend class='gfield_label gform-field-label' ><span class='gform-field-label__text'>Current Term<\/span><span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(Required)<\/span><\/span><\/legend><div class='ginput_container ginput_container_radio'><div class='gfield_radio' id='input_1_5'>\n\t\t\t<div class='gchoice gchoice_1_5_0'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_5' type='radio' value='Spring'  id='choice_1_5_0' onchange='gformToggleRadioOther( this )'  tabindex='1008'  \/>\n\t\t\t\t\t<label for='choice_1_5_0' id='label_1_5_0' class='gform-field-label gform-field-label--type-inline'>Spring<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_1_5_1'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_5' type='radio' value='Summer'  id='choice_1_5_1' onchange='gformToggleRadioOther( this )'  tabindex='1009'  \/>\n\t\t\t\t\t<label for='choice_1_5_1' id='label_1_5_1' class='gform-field-label gform-field-label--type-inline'>Summer<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_1_5_2'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_5' type='radio' value='Fall'  id='choice_1_5_2' onchange='gformToggleRadioOther( this )'  tabindex='1010'  \/>\n\t\t\t\t\t<label for='choice_1_5_2' id='label_1_5_2' class='gform-field-label gform-field-label--type-inline'>Fall<\/label>\n\t\t\t<\/div><\/div><\/div><\/fieldset><fieldset id=\"field_1_6\" class=\"gfield gfield--type-radio gfield--type-choice gfield--input-type-radio gfield--width-half gf_list_inline gfield_contains_required field_sublabel_below gfield--no-description field_description_above field_validation_below gfield_visibility_visible gfield--choice-align-vertical\"  ><legend class='gfield_label gform-field-label' ><span class='gform-field-label__text'>Are you graduating this term?<\/span><span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(Required)<\/span><\/span><\/legend><div class='ginput_container ginput_container_radio'><div class='gfield_radio' id='input_1_6'>\n\t\t\t<div class='gchoice gchoice_1_6_0'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_6' type='radio' value='Yes'  id='choice_1_6_0' onchange='gformToggleRadioOther( this )'  tabindex='1011'  \/>\n\t\t\t\t\t<label for='choice_1_6_0' id='label_1_6_0' class='gform-field-label gform-field-label--type-inline'>Yes<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_1_6_1'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_6' type='radio' value='No'  id='choice_1_6_1' onchange='gformToggleRadioOther( this )'  tabindex='1012'  \/>\n\t\t\t\t\t<label for='choice_1_6_1' id='label_1_6_1' class='gform-field-label gform-field-label--type-inline'>No<\/label>\n\t\t\t<\/div><\/div><\/div><\/fieldset><div id=\"field_1_10\" class=\"gfield gfield--type-select gfield--input-type-select gfield--width-half gfield_contains_required field_sublabel_below gfield--no-description field_description_above field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_1_10'><span class='gform-field-label__text'>Major<\/span><span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(Required)<\/span><\/span><\/label><div class='ginput_container ginput_container_select'><select name='input_10' id='input_1_10' class='large gfield_select' tabindex='1013'   aria-required=\"true\" aria-invalid=\"false\" ><option value='Please choose' >Please choose<\/option><option value='Addiction Studies Certificate (ASC) CERT' >Addiction Studies Certificate (ASC) CERT<\/option><option value='Adventure Education (ADE) AS' >Adventure Education (ADE) AS<\/option><option value='Allied Health (ALH) AS' >Allied Health (ALH) AS<\/option><option value='Allied Health\/Dental Assisting Intent (ALH) AS' >Allied Health\/Dental Assisting Intent (ALH) AS<\/option><option value='Allied Health\/Kinesiology Transfer Intent (ALH) AS' >Allied Health\/Kinesiology Transfer Intent (ALH) AS<\/option><option value='Allied Health\/LPN Intent (ALH) AS' >Allied Health\/LPN Intent (ALH) AS<\/option><option value='Allied Health\/Nutrition Transfer Intent (ALH) AS' >Allied Health\/Nutrition Transfer Intent (ALH) AS<\/option><option value='Allied Health\/PMC Intent (ALH) AS' >Allied Health\/PMC Intent (ALH) AS<\/option><option value='Allied Health\/Physical Therapy Assistant Intent (ALH) AS' >Allied Health\/Physical Therapy Assistant Intent (ALH) AS<\/option><option value='Allied Health\/Public Health Transfer Intent (ALH) AS' >Allied Health\/Public Health Transfer Intent (ALH) AS<\/option><option value='Allied Health\/Radiologic Technology Intent (ALH) AS' >Allied Health\/Radiologic Technology Intent (ALH) AS<\/option><option value='Allied Health\/Respiratory Therapy Intent (ALH) AS' >Allied Health\/Respiratory Therapy Intent (ALH) AS<\/option><option value='Allied Health\/RN Intent (ALH) AS' >Allied Health\/RN Intent (ALH) AS<\/option><option value='Allied Health\/SGT (ALH) AS' >Allied Health\/SGT (ALH) AS<\/option><option value='Art\/Visual Art Transfer Block (AVC) AS' >Art\/Visual Art Transfer Block (AVC) AS<\/option><option value='Art\/Visual Arts (AVA) AS' >Art\/Visual Arts (AVA) AS<\/option><option value='Biology (BIO) AS' >Biology (BIO) AS<\/option><option value='Business Administration General (BAG) AS' >Business Administration General (BAG) AS<\/option><option value='Business Administration Transfer (BAT) AA' >Business Administration Transfer (BAT) AA<\/option><option value='Chemistry (CHE) AS' >Chemistry (CHE) AS<\/option><option value='Computer Science (CSC) AS' >Computer Science (CSC) AS<\/option><option value='Early Childhood Education (ECE) AS' >Early Childhood Education (ECE) AS<\/option><option value='Early Childhood Education Certificate (CECE) CERT' >Early Childhood Education Certificate (CECE) CERT<\/option><option value='Engineering Science (EGS) AS' >Engineering Science (EGS) AS<\/option><option value='Environmental Conservation (ENC) AS' >Environmental Conservation (ENC) AS<\/option><option value='Farm and Food Systems (LFF) AA' >Farm and Food Systems (LFF) AA<\/option><option value='Fire Science Technology (FST) AS' >Fire Science Technology (FST) AS<\/option><option value='Human Services (HSE) AS' >Human Services (HSE) AS<\/option><option value='Justice Studies (JUS) AS' >Justice Studies (JUS) AS<\/option><option value='Liberal Arts (LIB) AA' >Liberal Arts (LIB) AA<\/option><option value='Liberal Arts\/Contemporary Music Studies (LCMS) AA' >Liberal Arts\/Contemporary Music Studies (LCMS) AA<\/option><option value='Liberal Arts\/Education (LEO) AA' >Liberal Arts\/Education (LEO) AA<\/option><option value='Liberal Arts\/English (LAE) AA' >Liberal Arts\/English (LAE) AA<\/option><option value='Liberal Arts\/Farm and Food Systems (LFF) AA' >Liberal Arts\/Farm and Food Systems (LFF) AA<\/option><option value='Liberal Arts\/History (LHI) AA' >Liberal Arts\/History (LHI) AA<\/option><option value='Liberal Arts\/Mathematics (LMA) AA' >Liberal Arts\/Mathematics (LMA) AA<\/option><option value='Liberal Arts\/Social Sciences (LSS) AA' >Liberal Arts\/Social Sciences (LSS) AA<\/option><option value='Liberal Arts\/Theater (LAT) AA' >Liberal Arts\/Theater (LAT) AA<\/option><option value='Management Certificate (MGT) CERT' >Management Certificate (MGT) CERT<\/option><option value='Medical Assistant Certificate (MAC) CERT' >Medical Assistant Certificate (MAC) CERT<\/option><option value='Music Recording and Production Certificate (MRP) CERT' >Music Recording and Production Certificate (MRP) CERT<\/option><option value='Outdoor Leadership Certificate (OLP) CERT' >Outdoor Leadership Certificate (OLP) CERT<\/option><option value='Pre-Nursing (NUC) CERT' >Pre-Nursing (NUC) CERT<\/option><option value='Pre-Nursing\/ADN Intent (NUC) CERT' >Pre-Nursing\/ADN Intent (NUC) CERT<\/option><option value='Pre-Nursing\/LPN Intent (NUC) CERT' >Pre-Nursing\/LPN Intent (NUC) CERT<\/option><option value='Pre-Nursing\/Nursing Bridge Intent (NUC) CERT ** ONLY AVAILABLE FOR PRACTICAL NURSES **' >Pre-Nursing\/Nursing Bridge Intent (NUC) CERT ** ONLY AVAILABLE FOR PRACTICAL NURSES **<\/option><option value='Visual Arts Certificate (VAC) CERT' >Visual Arts Certificate (VAC) CERT<\/option><option value='Web Development &amp; Design Certificate (WDD) CERT' >Web Development &amp; Design Certificate (WDD) CERT<\/option><option value='World Language in French (WFR) CERT' >World Language in French (WFR) CERT<\/option><option value='World Language in Spanish (WSP) CERT' >World Language in Spanish (WSP) CERT<\/option><\/select><\/div><\/div><fieldset id=\"field_1_8\" class=\"gfield gfield--type-checkbox gfield--type-choice gfield--input-type-checkbox gfield--width-half gfield_contains_required field_sublabel_below gfield--has-description field_description_above field_validation_below gfield_visibility_visible gfield--choice-align-vertical\"  ><legend class='gfield_label gform-field-label gfield_label_before_complex' ><span class='gform-field-label__text'>Status<\/span><span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(Required)<\/span><\/span><\/legend><div class='gfield_description' id='gfield_description_1_8'>Check all that apply<\/div><div class='ginput_container ginput_container_checkbox'><div class='gfield_checkbox ' id='input_1_8'><div class='gchoice gchoice_1_8_1'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_8.1' type='checkbox'  value='Returning GCC student'  id='choice_1_8_1' tabindex='1014'  aria-describedby=\"gfield_description_1_8\"\/>\n\t\t\t\t\t\t\t\t<label for='choice_1_8_1' id='label_1_8_1' class='gform-field-label gform-field-label--type-inline'>Returning GCC student<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_1_8_2'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_8.2' type='checkbox'  value='First time using VA education benefits'  id='choice_1_8_2' tabindex='1015'  \/>\n\t\t\t\t\t\t\t\t<label for='choice_1_8_2' id='label_1_8_2' class='gform-field-label gform-field-label--type-inline'>First time using VA education benefits<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_1_8_3'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_8.3' type='checkbox'  value='Used VA benefits at another institution'  id='choice_1_8_3' tabindex='1016'  \/>\n\t\t\t\t\t\t\t\t<label for='choice_1_8_3' id='label_1_8_3' class='gform-field-label gform-field-label--type-inline'>Used VA benefits at another institution<\/label>\n\t\t\t\t\t\t\t<\/div><\/div><\/div><\/fieldset><fieldset id=\"field_1_12\" class=\"gfield gfield--type-radio gfield--type-choice gfield--input-type-radio gfield--width-half gf_list_inline gfield_contains_required field_sublabel_below gfield--has-description field_description_above field_validation_below gfield_visibility_visible gfield--choice-align-vertical\"  ><legend class='gfield_label gform-field-label' ><span class='gform-field-label__text'>Program Change<\/span><span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(Required)<\/span><\/span><\/legend><div class='gfield_description' id='gfield_description_1_12'>Have you changed your degree program since the last semester you attended?<\/div><div class='ginput_container ginput_container_radio'><div class='gfield_radio' id='input_1_12'>\n\t\t\t<div class='gchoice gchoice_1_12_0'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_12' type='radio' value='No'  id='choice_1_12_0' onchange='gformToggleRadioOther( this )' aria-describedby=\"gfield_description_1_12\" tabindex='1017'  \/>\n\t\t\t\t\t<label for='choice_1_12_0' id='label_1_12_0' class='gform-field-label gform-field-label--type-inline'>No<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_1_12_1'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_12' type='radio' value='Yes'  id='choice_1_12_1' onchange='gformToggleRadioOther( this )'  tabindex='1018'  \/>\n\t\t\t\t\t<label for='choice_1_12_1' id='label_1_12_1' class='gform-field-label gform-field-label--type-inline'>Yes<\/label>\n\t\t\t<\/div><\/div><\/div><\/fieldset><fieldset id=\"field_1_9\" class=\"gfield gfield--type-checkbox gfield--type-choice gfield--input-type-checkbox gfield--width-full gfield_contains_required field_sublabel_below gfield--has-description field_description_above field_validation_below gfield_visibility_visible gfield--choice-align-vertical\"  ><legend class='gfield_label gform-field-label gfield_label_before_complex' ><span class='gform-field-label__text'>Benefits<\/span><span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(Required)<\/span><\/span><\/legend><div class='gfield_description' id='gfield_description_1_9'>What VA or Commonwealth educational benefits do you plan to use? <em>DD Form 214 must be submitted to your SCO.<\/em><\/div><div class='ginput_container ginput_container_checkbox'><div class='gfield_checkbox ' id='input_1_9'><div class='gchoice gchoice_1_9_1'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_9.1' type='checkbox'  value='Mass. Categorical Veteran Tuition &amp; Fee Waiver'  id='choice_1_9_1' tabindex='1019'  aria-describedby=\"gfield_description_1_9\"\/>\n\t\t\t\t\t\t\t\t<label for='choice_1_9_1' id='label_1_9_1' class='gform-field-label gform-field-label--type-inline'>Mass. Categorical Veteran Tuition &amp; Fee Waiver<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_1_9_2'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_9.2' type='checkbox'  value='Mass. National Guard Certificate of Eligibility (COE)'  id='choice_1_9_2' tabindex='1020'  \/>\n\t\t\t\t\t\t\t\t<label for='choice_1_9_2' id='label_1_9_2' class='gform-field-label gform-field-label--type-inline'>Mass. National Guard Certificate of Eligibility (COE)<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_1_9_3'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_9.3' type='checkbox'  value='Chapter 30 Montgomery GI Bill (MGIB)'  id='choice_1_9_3' tabindex='1021'  \/>\n\t\t\t\t\t\t\t\t<label for='choice_1_9_3' id='label_1_9_3' class='gform-field-label gform-field-label--type-inline'>Chapter 30 Montgomery GI Bill (MGIB)<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_1_9_4'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_9.4' type='checkbox'  value='Chapter 31 Veteran Readiness &amp; Employment (VR&amp;E)'  id='choice_1_9_4' tabindex='1022'  \/>\n\t\t\t\t\t\t\t\t<label for='choice_1_9_4' id='label_1_9_4' class='gform-field-label gform-field-label--type-inline'>Chapter 31 Veteran Readiness &amp; Employment (VR&amp;E)<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_1_9_5'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_9.5' type='checkbox'  value='Chapter 33 Post 9\/11 GI Bill'  id='choice_1_9_5' tabindex='1023'  \/>\n\t\t\t\t\t\t\t\t<label for='choice_1_9_5' id='label_1_9_5' class='gform-field-label gform-field-label--type-inline'>Chapter 33 Post 9\/11 GI Bill<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_1_9_6'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_9.6' type='checkbox'  value='Chapter 35 Dependents Educational Assistance (DEA)'  id='choice_1_9_6' tabindex='1024'  \/>\n\t\t\t\t\t\t\t\t<label for='choice_1_9_6' id='label_1_9_6' class='gform-field-label gform-field-label--type-inline'>Chapter 35 Dependents Educational Assistance (DEA)<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_1_9_7'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_9.7' type='checkbox'  value='Chapter 1606 Montgomery GI Bill Selective Reserve (MGIB-SR)'  id='choice_1_9_7' tabindex='1025'  \/>\n\t\t\t\t\t\t\t\t<label for='choice_1_9_7' id='label_1_9_7' class='gform-field-label gform-field-label--type-inline'>Chapter 1606 Montgomery GI Bill Selective Reserve (MGIB-SR)<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_1_9_8'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_9.8' type='checkbox'  value='Not sure, connect me to an advisor'  id='choice_1_9_8' tabindex='1026'  \/>\n\t\t\t\t\t\t\t\t<label for='choice_1_9_8' id='label_1_9_8' class='gform-field-label gform-field-label--type-inline'>Not sure, connect me to an advisor<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_1_9_9'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_9.9' type='checkbox'  value='Other'  id='choice_1_9_9' tabindex='1027'  \/>\n\t\t\t\t\t\t\t\t<label for='choice_1_9_9' id='label_1_9_9' class='gform-field-label gform-field-label--type-inline'>Other<\/label>\n\t\t\t\t\t\t\t<\/div><\/div><\/div><\/fieldset><fieldset id=\"field_1_13\" class=\"gfield gfield--type-checkbox gfield--type-choice gfield--input-type-checkbox gfield--width-full gfield_contains_required field_sublabel_below gfield--has-description field_description_above field_validation_below gfield_visibility_visible gfield--choice-align-vertical\"  ><legend class='gfield_label gform-field-label gfield_label_before_complex' ><span class='gform-field-label__text'>Remedial Courses<\/span><span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(Required)<\/span><\/span><\/legend><div class='gfield_description' id='gfield_description_1_13'>Are you registered for any remedial courses? The VA will <strong>not cover<\/strong> online-only remedial courses. The VA will only accept <strong>in-person or hybrid<\/strong> remedial courses.<\/div><div class='ginput_container ginput_container_checkbox'><div class='gfield_checkbox ' id='input_1_13'><div class='gchoice gchoice_1_13_1'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_13.1' type='checkbox'  value='Math'  id='choice_1_13_1' tabindex='1028'  aria-describedby=\"gfield_description_1_13\"\/>\n\t\t\t\t\t\t\t\t<label for='choice_1_13_1' id='label_1_13_1' class='gform-field-label gform-field-label--type-inline'>Math<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_1_13_2'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_13.2' type='checkbox'  value='English'  id='choice_1_13_2' tabindex='1029'  \/>\n\t\t\t\t\t\t\t\t<label for='choice_1_13_2' id='label_1_13_2' class='gform-field-label gform-field-label--type-inline'>English<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_1_13_3'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_13.3' type='checkbox'  value='Not registered for any remedial courses'  id='choice_1_13_3' tabindex='1030'  \/>\n\t\t\t\t\t\t\t\t<label for='choice_1_13_3' id='label_1_13_3' class='gform-field-label gform-field-label--type-inline'>Not registered for any remedial courses<\/label>\n\t\t\t\t\t\t\t<\/div><\/div><\/div><\/fieldset><div id=\"field_1_14\" class=\"gfield gfield--type-text gfield--input-type-text gfield--width-full gfield_contains_required field_sublabel_below gfield--has-description field_description_above field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_1_14'><span class='gform-field-label__text'>Credit Hours<\/span><span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(Required)<\/span><\/span><\/label><div class='gfield_description' id='gfield_description_1_14'><strong>How many credits are you taking this term?<\/strong> You must register for a <strong>minimum of five (5) credits<\/strong> to qualify for chapter benefits and <strong>12 credits in-person<\/strong> to qualify for 100% BAH (MHA). Each online credit class will lower your BAH (MHA).  \n\nAll changes made to registration after the add\/drop period must be reported to the Veteran Service Advisor immediately. <\/div><div class='ginput_container ginput_container_text'><input name='input_14' id='input_1_14' type='text' value='' class='large'  aria-describedby=\"gfield_description_1_14\" tabindex='1031'  aria-required=\"true\" aria-invalid=\"false\"   \/><\/div><\/div><fieldset id=\"field_1_15\" class=\"gfield gfield--type-radio gfield--type-choice gfield--input-type-radio gfield--width-half gf_list_inline gfield_contains_required field_sublabel_below gfield--has-description field_description_above field_validation_below gfield_visibility_visible gfield--choice-align-vertical\"  ><legend class='gfield_label gform-field-label' ><span class='gform-field-label__text'>Clinical Hours<\/span><span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(Required)<\/span><\/span><\/legend><div class='gfield_description' id='gfield_description_1_15'>Will you have clinical (clocked) hours this term?<\/div><div class='ginput_container ginput_container_radio'><div class='gfield_radio' id='input_1_15'>\n\t\t\t<div class='gchoice gchoice_1_15_0'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_15' type='radio' value='Yes'  id='choice_1_15_0' onchange='gformToggleRadioOther( this )' aria-describedby=\"gfield_description_1_15\" tabindex='1032'  \/>\n\t\t\t\t\t<label for='choice_1_15_0' id='label_1_15_0' class='gform-field-label gform-field-label--type-inline'>Yes<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_1_15_1'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_15' type='radio' value='No'  id='choice_1_15_1' onchange='gformToggleRadioOther( this )'  tabindex='1033'  \/>\n\t\t\t\t\t<label for='choice_1_15_1' id='label_1_15_1' class='gform-field-label gform-field-label--type-inline'>No<\/label>\n\t\t\t<\/div><\/div><\/div><\/fieldset><div id=\"field_1_16\" class=\"gfield gfield--type-text gfield--input-type-text gfield--width-half gfield_contains_required field_sublabel_below gfield--has-description field_description_above field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_1_16'><span class='gform-field-label__text'>Course<\/span><span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(Required)<\/span><\/span><\/label><div class='gfield_description' id='gfield_description_1_16'>Provide name and course number<\/div><div class='ginput_container ginput_container_text'><input name='input_16' id='input_1_16' type='text' value='' class='large'  aria-describedby=\"gfield_description_1_16\" tabindex='1034'  aria-required=\"true\" aria-invalid=\"false\"   \/><\/div><\/div><fieldset id=\"field_1_18\" class=\"gfield gfield--type-radio gfield--type-choice gfield--input-type-radio gfield--width-full gf_list_inline gfield_contains_required field_sublabel_below gfield--has-description field_description_above field_validation_below gfield_visibility_visible gfield--choice-align-vertical\"  ><legend class='gfield_label gform-field-label' ><span class='gform-field-label__text'>Financial Aid<\/span><span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(Required)<\/span><\/span><\/legend><div class='gfield_description' id='gfield_description_1_18'>Have you applied for financial aid? E.g., FAFSA, Pell Grant, free community college, etc.<\/div><div class='ginput_container ginput_container_radio'><div class='gfield_radio' id='input_1_18'>\n\t\t\t<div class='gchoice gchoice_1_18_0'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_18' type='radio' value='Yes'  id='choice_1_18_0' onchange='gformToggleRadioOther( this )' aria-describedby=\"gfield_description_1_18\" tabindex='1035'  \/>\n\t\t\t\t\t<label for='choice_1_18_0' id='label_1_18_0' class='gform-field-label gform-field-label--type-inline'>Yes<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_1_18_1'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_18' type='radio' value='No'  id='choice_1_18_1' onchange='gformToggleRadioOther( this )'  tabindex='1036'  \/>\n\t\t\t\t\t<label for='choice_1_18_1' id='label_1_18_1' class='gform-field-label gform-field-label--type-inline'>No<\/label>\n\t\t\t<\/div><\/div><\/div><\/fieldset><fieldset id=\"field_1_17\" class=\"gfield gfield--type-radio gfield--type-choice gfield--input-type-radio gfield--width-full gf_list_inline gfield_contains_required field_sublabel_below gfield--has-description field_description_above field_validation_below gfield_visibility_visible gfield--choice-align-vertical\"  ><legend class='gfield_label gform-field-label' ><span class='gform-field-label__text'>Health Insurance<\/span><span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(Required)<\/span><\/span><\/legend><div class='gfield_description' id='gfield_description_1_17'>All students taking a minimum of nine (9) credits must carry <a href=\"\/sfs\/health-insurance\/\" target=\"_blank\">health insurance<\/a>.<\/div><div class='ginput_container ginput_container_radio'><div class='gfield_radio' id='input_1_17'>\n\t\t\t<div class='gchoice gchoice_1_17_0'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_17' type='radio' value='GCC'  id='choice_1_17_0' onchange='gformToggleRadioOther( this )' aria-describedby=\"gfield_description_1_17\" tabindex='1037'  \/>\n\t\t\t\t\t<label for='choice_1_17_0' id='label_1_17_0' class='gform-field-label gform-field-label--type-inline'>I'm covered by GCC student health insurance<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_1_17_1'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_17' type='radio' value='Waived'  id='choice_1_17_1' onchange='gformToggleRadioOther( this )'  tabindex='1038'  \/>\n\t\t\t\t\t<label for='choice_1_17_1' id='label_1_17_1' class='gform-field-label gform-field-label--type-inline'>I have waived GCC student health insurance and am covered by a comparable policy<\/label>\n\t\t\t<\/div><\/div><\/div><\/fieldset><fieldset id=\"field_1_19\" class=\"gfield gfield--type-radio gfield--type-choice gfield--input-type-radio gfield--width-full gf_list_inline gfield_contains_required field_sublabel_below gfield--has-description field_description_above field_validation_below gfield_visibility_visible gfield--choice-align-vertical\"  ><legend class='gfield_label gform-field-label' ><span class='gform-field-label__text'>Repeat Coursework<\/span><span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(Required)<\/span><\/span><\/legend><div class='gfield_description' id='gfield_description_1_19'>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.<\/div><div class='ginput_container ginput_container_radio'><div class='gfield_radio' id='input_1_19'>\n\t\t\t<div class='gchoice gchoice_1_19_0'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_19' type='radio' value='No'  id='choice_1_19_0' onchange='gformToggleRadioOther( this )' aria-describedby=\"gfield_description_1_19\" tabindex='1039'  \/>\n\t\t\t\t\t<label for='choice_1_19_0' id='label_1_19_0' class='gform-field-label gform-field-label--type-inline'>I am not registered for any courses that I have successfully completed in a previous semester<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_1_19_1'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_19' type='radio' value='Yes'  id='choice_1_19_1' onchange='gformToggleRadioOther( this )'  tabindex='1040'  \/>\n\t\t\t\t\t<label for='choice_1_19_1' id='label_1_19_1' class='gform-field-label gform-field-label--type-inline'>I am registered for a repeat class that I failed previously, or my program requires a higher grade than previously earned<\/label>\n\t\t\t<\/div><\/div><\/div><\/fieldset><fieldset id=\"field_1_20\" class=\"gfield gfield--type-consent gfield--type-choice gfield--input-type-consent gfield--width-full gfield_contains_required field_sublabel_below gfield--has-description field_description_above field_validation_below gfield_visibility_visible gfield--choice-align-vertical\"  ><legend class='gfield_label gform-field-label gfield_label_before_complex' ><span class='gform-field-label__text'>Acknowledgement &amp; Consent<\/span><span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(Required)<\/span><\/span><\/legend><div class='gfield_description gfield_consent_description' id='gfield_consent_description_1_20'><div 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