Please return this form to the Great Bay Community College One Stop, 320 Corporate Drive Portsmouth, NH 03801, 603-427-7610
High School Completion/Equivalent Self-Certification Form
Name: ____________________________________ Date of Birth:__________________
Choose the option that applies to you and fill in the information:
I certify that I have successfully graduated from high school with a standard diploma:
__________________ ______________________________ _______________________
Date: Month and Year Name of School City and State
I certify I have successfully completed a homeschool program:
Date: Month and Year _________________________
I certify I have successfully completed a GED/HiSET
Date: Month and Year __________________________
I certify that I have NOT yet graduated and received a high school diploma, federal aid eligible homeschool
credential, or GED/HiSET. I will complete this requirement:
Date: Month and Year __________________________
I certify that I have not graduated from a high school, homeschool, or GED/HiSET and do not plan to in the future.
(be aware that you will likely not be eligible to receive any Title IV federal financial aid funds)
My signature below certifies 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. 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 strongly encouraged
to submit transcripts in order to be accurately placed into college courses.
____________________________________ ____________________
Signature Date
Terms of Use (electronic signatures): The Community College System of New Hampshire (CCSNH) uses electronic signatures and records in place of traditional ones whenever possible. You will conduct business
electronically with CCSNH using a computer with a supported operating system and internet browser, sufficient electronic storage capacity, a printer and your official CCSNH email account. By logging into CCSNH systems,
including but not limited to Banner SIS and Canvas, you are opting to conduct electronic transactions with the Community College System and consenting to receive written notices electronically, including those involving
financial obligations, and you are acknowledging that CCSNH can use electronic mechanisms alone to convey critical information related to your admission, financial aid, payment plan, student account, transcript
information, registration and other activities and accounts you may undertake or have as a student at CCSNH. You have a right to request a paper copy of an electronic record. You may withdraw your consent at any time
by contacting the One Stop. If you decide to withdraw your consent, however, you may be prevented from registering for classes.
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