Learner Selection Verification Form
Please complete this form to verify a learner’s selection status for a program, course, cohort, or training opportunity.
Learner Full Name
*
First Name
Last Name
Learner Email Address
*
example@example.com
Program / Course / Cohort Name
*
Type of Opportunity
*
Please Select
Program
Course
Cohort
Training
Other
Selection Status
*
Selected
Not Selected
Waitlisted
Selection Date
 -
Month
 -
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Verifier Name
*
First Name
Last Name
Verifier Email Address
*
example@example.com
Verifier Role or Position
Additional Comments (optional)
Submit Verification
Should be Empty: