12745 College Drive, Glenns, VA 23149-2616 / 804-758-6700 (TDD 758-6760)

12745 College Drive, Glenns, VA 23149-2616 / 804-758-6700 (TDD 758-6760)

52 Campus Drive, Warsaw, VA 22572-4272 / 804-333-6700 (TDD 333-6760)

2017-2018

STATEMENT OF DEGREE STATUS

Please circle the response that applies:

I certify the following statement to be true and correct:

I, ________________________________________Student ID#________________

have or have not received nor am presently working on a Bachelor’s Degree or higher.

_____________________________ ______________________

Student Signature Date

Please Note: Further documentation may be required, i.e. proof of separate domiciles; order of child support and/or spousal support, etc.

As per the United States Department of Education, “If you purposely give false or misleading information, you may be fined $20,000 set to prison, or both.”

12/01/16

Virginia Community College System