ENROLLMENT VERIFICATION FORM

PLEASE REQUEST IN WRITING WHICH SEMESTER YOU WANT VERIFIED:

(ONLY THOSE WHICH YOU ARE REGISTERED FOR OR HAVE PREVIOUSLY TAKEN)

DATES OF ATTENDANCE TO BE VERIFIED ________  ______ TO______  _____ 

                                                                                     MONTH      YEAR          MONTH    YEAR

                                        HALF TIME STUDENT_____

YOUR EXPECTED GRADUATION DATE __________________________________

CHECK ONE: TO BE PICKED UP ON THE FOLLOWING DATE _________________

                                                               - OR -

                       TO BE MAILED TO THE FOLLOWING ADDRESS:

PLEASE PRINT YOUR FULL NAME:__________________________________________