Dat
e of Request: Number of copies requested:
Student ID: Are you currently enrolled? ☐Yes ☐No
TYPE OF INFORMATION TO BE VERIFIED:
Name: If no box is checked, a verification of enrollment for the current term will be processed.
Other name or alias: ☐Verification for enrollment for:
Term/Year
Street Address:
☐Letter of non-attendance for:
City, State, Zip: Term/Year
☐Verification of degree(s) earned at Las Positas College
Phone: ☐Complete the attached inquiry form.
Special Instructions:
Birthdate:
☐Se
nd verification to: ☐Student pick at Office of Admissions & Records
(Photo ID required)
NAM
E/INSTITUTION:
ATTEN
TION:
ADD
RESS:
Number, Street,
City, State & Zip
Stu
dent’s signature authorizing release of enrollment verification Date:
Typ
e of payment: Discover/Visa/Mastercard #: Expiration date:
I authorized Las Positas College to charge my card for the following amount: $ Cardholder’s signature:
ENROLLMENT VERIFICATION POLICIES
1. Please allow at least five (5) business days for processing – first two are free, each additional is $2.00
2. Las Positas College will forward record of work completed at Chabot and/or Las Positas Community Colleges
only. Information regarding course work completed at other institutions are NOT included.
3. If sending verifications to different recipients, please use separate form for each request.
Mail this form to: Las Positas College, Attn: Enrollment Verification, 3000 Campus Hill Drive, Livermore, CA 94551
Fax to: (925) 606-6437 Attn: Enrollment Verification
Email to: lpc-admissions@laspositascollege.edu
Attn: Enrollment Verification
BUSINESS OFFICE USE ONLY
AMOU
NT PAID $: RECEIVED BY: DATE SENT:
3000 Campus Hill Drive
OFFICE OF ADMISSIONS & RECORDS
Livermore, CA 94551
Tel: (925) 424-1500
Fax: (925) 606-6437
www.laspositascollege.edu/admissions
PLEASE TYPE OR PRINT LEGIBLY
ENROLLMENT VERIFICATION REQUEST
