Home Enroll at MGCCC Apply for Admission Military Students Military Services Verification of Enrollment Form Has any information changed since your last certification?*YesNoDate of Birth* Date Format: MM slash DD slash YYYY Name* First Last Address* Street Address Address Line 2 City State / Province / Region ZIP / Postal Code AfghanistanAlbaniaAlgeriaAmerican SamoaAndorraAngolaAnguillaAntarcticaAntigua and BarbudaArgentinaArmeniaArubaAustraliaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBermudaBhutanBoliviaBonaire, Sint Eustatius and SabaBosnia and HerzegovinaBotswanaBouvet IslandBrazilBritish Indian Ocean TerritoryBrunei DarussalamBulgariaBurkina FasoBurundiCambodiaCameroonCanadaCape VerdeCayman IslandsCentral African RepublicChadChileChinaChristmas IslandCocos IslandsColombiaComorosCongo, Democratic Republic of theCongo, Republic of theCook IslandsCosta RicaCroatiaCubaCuraçaoCyprusCzech RepublicCôte d'IvoireDenmarkDjiboutiDominicaDominican RepublicEcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEswatini (Swaziland)EthiopiaFalkland IslandsFaroe IslandsFijiFinlandFranceFrench GuianaFrench PolynesiaFrench Southern TerritoriesGabonGambiaGeorgiaGermanyGhanaGibraltarGreeceGreenlandGrenadaGuadeloupeGuamGuatemalaGuernseyGuineaGuinea-BissauGuyanaHaitiHeard and McDonald IslandsHoly SeeHondurasHong KongHungaryIcelandIndiaIndonesiaIranIraqIrelandIsle of ManIsraelItalyJamaicaJapanJerseyJordanKazakhstanKenyaKiribatiKuwaitKyrgyzstanLao People's Democratic RepublicLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacauMacedoniaMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMartiniqueMauritaniaMauritiusMayotteMexicoMicronesiaMoldovaMonacoMongoliaMontenegroMontserratMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNew CaledoniaNew ZealandNicaraguaNigerNigeriaNiueNorfolk IslandNorth KoreaNorthern Mariana IslandsNorwayOmanPakistanPalauPalestine, State ofPanamaPapua New GuineaParaguayPeruPhilippinesPitcairnPolandPortugalPuerto RicoQatarRomaniaRussiaRwandaRéunionSaint BarthélemySaint HelenaSaint Kitts and NevisSaint LuciaSaint MartinSaint Pierre and MiquelonSaint Vincent and the GrenadinesSamoaSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSint MaartenSlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSouth GeorgiaSouth KoreaSouth SudanSpainSri LankaSudanSurinameSvalbard and Jan Mayen IslandsSwedenSwitzerlandSyriaTaiwanTajikistanTanzaniaThailandTimor-LesteTogoTokelauTongaTrinidad and TobagoTunisiaTurkeyTurkmenistanTurks and Caicos IslandsTuvaluUS Minor Outlying IslandsUgandaUkraineUnited Arab EmiratesUnited KingdomUnited StatesUruguayUzbekistanVanuatuVenezuelaVietnamVirgin Islands, BritishVirgin Islands, U.S.Wallis and FutunaWestern SaharaYemenZambiaZimbabweÅland Islands Country MGCCC ID (M) Number*Last 4 digits of social security number*MGCCC Email* Enter Email Confirm Email Daytime Phone*Campus*Harrison County CampusKeesler CenterNavy BasePerkinston CampusGeorge County CampusJackson County CampusBryant Center at TraditionWest Harrison CenterMilitary Status*VeteranActiveReserveDependentSpouseBranch of Service*ArmyNational GuardNavyAir ForceMarinesCoast GuardVA Education Benefit Chapter Information*33 (Post 9/11)33 (Post 9/11) Spouse33 (Post 9/11) Dependent33 (FRY)30 (Montgomery GI Bill)31 (Voc. Rehab)(Active Duty)35 (Dependent)1606 (Reserve/Nat'l Guard)(VA Workstudy)Percent of Benefit*10%20%30%40%50%60%70%80%90%100%VA File Number*Student Status*New Incoming (1st time using VA benefits)Student Recertification (Returning Student)Transfer StudentGuest StudentTransfer Student to MGCCC from*School NameNOTE: All transfer students must complete a Change of Place of Training Form (22-1995 or 22-5495) at https://www.va.gov/Guest Student Parent School*School NameProgram*Area of Interest*Program Type*Academic ProgramCareer Technical ProgramLevel of Pursuit*DiplomaCertificateAssociate's DegreeAre you transferring to another college or university?*YesNoTransferring from MGCCC to*School NameTerm requesting to be certified:*FallSpringSummerYear requesting to be certified:*Statement of UnderstandingVA Regional Office submission* I understand before my enrollment certification can be submitted to the VA Regional Office to begin benefits,1. I must have the following documents on file with the Admissions office: - Application for admission- All official college/school transcripts or high school equivalence diploma- Official military transcript (service members)2. I must submit a Certificate of Eligibility (COE) to Military Services.3. I must submit a Verification of Enrollment (VOE) form to Military Services each semester to request certification.Responsibility for charges* I understand I will be responsible for all charges associated with courses ineligible for certification 1. Courses not required for the current program of study and listed on the degree plan 2. Courses previously passed with a "D" or better; exception, MGCCC programs that require a "C" or better for acceptance. 3. Any remedial courses (E.G. Beginning English, Beginning Algebra, etc.) taken online. Responsibility to report changes* I understand failure to report the following immediately may result in a debt for which I am responsible. 1. Schedule changes (additions, withdrawals, term dates, audits etc.) to the Military Services Center). 2. Scholarships receivedResponsibility for advisement and document submission* I understand that I must meet with an advisor every semester and submit all required documents to Military Services. Email confirmation of certification* I understand the VA will send a confirmation to my MGCCC student email once certification is complete.Digital Signature*