High School Completion/Equivalent
Self-Certification Form
Name: _____________________________________ D.O.B.______________________________
Please choose the one that applies to you and fill in the information:
☐ I certify that I have graduated or will graduate from high school or have received the equivalent
of a high school diploma (e.g., accredited alternative diploma program, HiSET or GED) by the
start date of the semester for which I am applying.
____________________ ______________________ ________________________________
Graduating Month and Year Name of School City and State
☐ I certify that I will not have graduated from high school or have received the equivalent of a
high school diploma (e.g., accredited alternative diploma program, HiSET or GED) by the start
date of the semester for which I am applying.
____________________ ______________________ ________________________________
Graduating Month and Year Name of School City and State
I understand that if I provide false information about graduation from high school or equivalent, I may
be required to return any Title IV financial aid funds I receive. Falsification of records could also result
in disciplinary action from the college, including expulsion.
Transcripts may be used in course placement, and specific academic programs may require submission
of high school transcripts, including for proof of successful completion of specific courses; therefore,
students are encouraged to submit transcripts in order to be accurately placed into college courses.
_________________________________________ __________________________
Signature Date
Nashua Community College | 505 Amherst Street, Nashua NH 03063 | P. 603 578-8908 | nashua@ccsnh.edu |nashuacc.edu
4-27-20 LT
