DocuSign Envelope ID: D38A53DC-2B65-4ADF-9225-3C328EB40AAD

Attestation Form

Douglas Jore
I, _________________________________________________________ (legal name), have applied for admission to Southern
New Hampshire University (SNHU). I understand that one requirement for admission to SNHU is graduation from a high
school or the successful completion of a high-school equivalency exam. If my high school education was completed
outside of the United States, I understand that my credential must be equivalent to a United States High School diploma.

Student Information:

Student Name at Time of Attendance Douglas Jore Date of Birth (MM/DD/YYYY) 05 / 04 / 1969

I hereby certify that:

I have graduated and received or will graduate and receive a high school diploma X Yes No

Name of high school: Williston high school Date of Graduation (MM/YYYY) 05 / 1987

City, State, Country: Williston, N.D.,U.S.A.

If for any reason this attestation of high school graduation or GED completion is found to be false or untrue, I understand
that I will not have met an admission requirement of SNHU, and thus I will not be considered a regular student and will be
subject to immediate dismissal from SNHU.
Furthermore, I understand that if this attestation is found to be false or untrue, all Title IV financial aid and any state or
institutional financial aid that was distributed on my behalf must be refunded to the appropriate source and that I will be
responsible for payment to SNHU for any and all money refunded.
By my signature below, I attest that the information provided above is true and correct to the best of my knowledge.
Further, I authorize Southern New Hampshire University to contact my high school or high school equivalency exam
administrators to confirm the accuracy of the above information.

Student Signature: Date: 11/6/2023

douglasjore3@gmail.com
Email Address:

06/2022