320 Corporate Drive, Portsmouth, NH 03801
Phone (603) 427-7600 Fax (603) 334-6308
NEW HAMPSHIRE SENIOR CITIZEN AGE VERIFICATION FORM
Adult Learners aged 65 and over and who are NH residents may enroll in academic credit
courses at a tuition cost of 50% at Great Bay Community College two (2) days prior to the start
of classes if space is available. Lab and other fees must be paid by the student.
(Full tuition, lab, and other fess will be charged for all non-credit, enrichment, professional
development, and recertification classes.)
This is to certify that
Student Name: __________________________________ ID#: A ________________________
is an adult learner aged 65 or over and a New Hampshire resident.
Date of birth is _____/_____/_____as verified by one of the following:
Driver’s License Number _______________________________
Birth Certificate _______________________________
Other (identify) _______________________________
New Hampshire residency is verified by one of the following:
NH Driver’s License Issue Date _______________________________
NH Car Registration Date _______________________________
Other (identify) _______________________________
VP approval: ___________________________ Date: _______________________
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