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I certify that the above statements are true and correct in all respects. Signature. Date. Download NH Vocational Rehabilitation Provider Certification Form – State Government (New Hampshire) form.Fill Out The Application For Nh Vocational Rehabilitation Provider Certification - New Hampshire Online And Print It Out For Free. Fill out the form in our online filing application. Expiration Date: September 25, 2021; MOU: NH Works Comprehensive Certification Term or Date of First Signature: September 28, 2019 It will help VA process your claim if you attach a certified copy of. "Member 4 Copy" of your DD Form 214 for each period of active service. Here is a list of some of the agencies Plymouth State University works with: New Hampshire. The Fiscal Unit provides the Certification Regarding Lobbying Form (ED 80-0013). 2 in any form of employment or education (defined as above but including people on training courses or full or part‐time education); 1.