Enrollment Verification Form
Student Name
First Name
Last Name
Date of Birth
 -
Month
 -
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Student ID
Email
Requesting Semester
Fall
Spring
Summer 1
Summer 2
Requesting Year
Future Enrollment Exemption
Scholarship
Military
Child Care Services
Social Security
Will the student or an authorized person pick up the verification on campus?
Yes
No
Authorized Pick Up Person's Name
First Name
Last Name
Needed for Military purposes?
Yes
No
How many copies are requested?
Do you have any notes for the office?
Date
 -
Month
 -
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Signature
Submit
Should be Empty: