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Enrollment Verification Request
Caldwell Community College and Technical Institute
Caldwell Campus 828.726.2200 Watauga Campus 828.297.2185
Personal Information
Name______________________________________________________ Student ID or SS# __________________________
Last First (Middle)
Date of Birth_______/_______/_________ Other Names You May Have Used ____________________________________
Home Phone No. ____________________ Work Phone No. __________________ Cell Phone No. __________________
Method of Delivery
To be picked up (Photo ID Required)
Pick up on Caldwell Campus
Pick up on Watauga Campus
To be mailed
Address for Enrollment Verification Delivery (Required):
Name of Institution/Person
Use the space to the right to indicate the mailing address
where the verification(s) should be sent. This address will
Address Line 1
appear on the outside of the verification envelope.
Note: You must use separate forms if you wish to send
Address Line 2
enrollment verification to more than one location.
City State Zip Code
My signature below authorizes release of my student records.
Student Signature ____________________________ Date: _____________________
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