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CCC REQUEST FOR VA ENROLLMENT CERTIFICATION Academic Year 2010 2010 (Fall 2010 Spring 2011 Summer 2011) This form must be completed before any certification can be made NAME MAJOR FALL 2010 Check

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This form must be filled out accurately and completely with all required information.

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The purpose of this form must be to report income and fulfill tax obligations.

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Information such as income, deductions, and credits must be reported on this form.

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