This form must be completed each semester to re-certify for continued enrollment. Personal Information First Name Last Name GRCC Email Phone Student ID Address Information Address City State - Select -AlabamaAlaskaAmerican SamoaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarshall IslandsMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Marianas IslandsOhioOklahomaOregonPalauPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirgin IslandsVirginiaWashingtonWest VirginiaWisconsinWyoming Zip Chapter Chapter Chapter 30 Montgomery Chapter 31 Vocational Rehabilitation Chapter 33 Post 9/11 Chapter 35 Survivor's and Dependent Educational Assistance Program Chapter 1606 Selected Reserve Chapter 1607 Reserve Educational Assistance Program (REAP) If Chapter 33 are you a: Veteran Dependent using transferred benefit Degree and Course Information Degree - Select -Associates in ArtsAssociates in ScienceAssociates in MusicAssociates in BusinessAssociates in NursingAssociates in Fine ArtsAssociates in Applied Arts and SciencesCertificate Major Have you applied for a secondary admit program such as Police Academy, Associate Degree Nursing, etc.? Yes No Secondary Admit Program - Select -Police AcademyAssociate Degree NursingLicensed Practical NursingOccupational Therapy AssistantRadiologic TechnologyDental HygieneDental Assistant Semester - Select -FallWinterSummer Year Are you repeating any classes this semester? Yes No What classes are you repeating? Why are you repeating this class? Transfer Credit Required by GRCC Program Failed Class Other Please go into detail: Confirmation Confirmation I confirm that all the information submitted here is accurate I understand that all the classes I am enrolled in for the upcoming semester must pertain to the degree I am completing. I have reviewed my requirements through MyDegreePath. I understand any changes to my classes must be reported to the GRCC Veterans Affairs Certifying Official. Normal Processing is 10 business days. An email will be sent for confirmation.