Revised 9/2020
REQUEST FOR VERIFICATION OF ENROLLMENT
Request will be processed within 2-3 business days.
Please print or type unless signature is requested.
Student’s Name _________________________________________________________________
Date of Birth _______________________________________
Student ID# ________________
Email _____________________________________________
Phone ____________________
Semester for which you are requesting verification: ____________________________________
Reason for request:
______________________________________________________________________________
______________________________________________________________________________
Please indicate the information to whom the letter is being written.
Name of Contact Person
__________________________________________________________
Dept., Agency, Orgaization, etc.
__________________________________________________________
Mailing Address
__________________________________________________________
City, State, Zip Code
__________________________________________________________
Please check one of the following options.
Student Pick Up
________ (Must be picked up within 30 days of request)
Mail Verification to Address Above
________
Fax Verification
________ Fax Number: ___________________________________
Email Verification
________ Email: ________________________________________
Date ___________________
*Submit the completed form to the Registrars Office.