Type of Verification Needed:        Enrollment           Degree

Student Information

Name:

Student ID No.:

Date(s) of Enrollment:  
                                              (please list semester to be verified, i.e., Fall 2005)

Degree(s):

Year of Graduation or Anticipated Graduation:

Requestor Information

Name: (Required)

Phone Number:(include area code)

Email: (Required)

Check here for an UNOFFICIAL EMAIL response. (must provide email address above)
            Emailed verification will not be issued on official letterhead and is not an official document.

Check here for a WRITTEN response and complete the following.

Street Address 1:

Street Address 2:

City:

State:

Zip Code:

Check here for a FAXED response and complete the following.

FAX Number: (include area code)