Enrollment Verication Request
Submit completed form by email to MJCESeForms@mjc.edu, Electronically signed forms will ONLY be
processed when using your MJC Student Email.
The rst two verication requests are FREE (expedited processing excluded). There will be a charge for subsequent
verication requests. For expedited processing you can choose same day or two business day. See the MJC website
for pricing or ask an Enrollment Services sta member. When submitting this form using a personal email, Signature
MUST BE COMPLETED IN BLUE OR BLACK INK. Verication Requests will be processed within 5-7 business days from receipt of
request. Verications not picked up within 60 days will be discarded!
Please Note: Your enrollment verication will be based on the number of units you are enrolled in when Enrollment Services processes this request. Adding and/
or dropping classes between the time of this request and the actual processing date may aect the number of units reported on this verication.
Today’s Date:
Student Information:
First Name: Middle Initial: Last Name:
Student ID: w Birthdate: Phone:
Information to be Veried:
Enrollment Status - Semester/ Year to be veried:
Grade Point Average - Cumulative (unless otherwise stated)
Academic Program/Declared Major
Vehicle Insurance -
Must be full-time, includes current enrollment and a minimum GPA of 3.0 for the previous semester.
Other:
Check Only One Box for Type of Delivery:
Send to my MJC student email account Pick up in Enrollment Services Oce
Mail to address listed below
Name (Company or Self):
Attention To:
Mailing Address:
By signing below I understand I am giving consent for MJC to send my verication status to the information I listed or I must pick up the
verication in-person in the Enrollment Services Oce and must bring a valid picture ID and have a zero dollar balance.
Student Signature: Date:
OFFICE USE ONLY
Posted By: Posted Date: First Free Second Free RQSS
Processed By: Processed Date: Amount Owed: Paid
Comments:
Student Signature: Date Picked Up:
Sta Initials: Date: Mailed Emailed
* Please bring your photo ID to pick up verication
*If you would like someone else to pickup your verication
please write their name below:
Note: Person listed above must bring valid photo ID and a
written letter signed by you in order to pickup your request.
03/2020_SJB
MJC Enrollment Services • Phone (209)575-6853 • FAX (209)575-6859
EAST 435 College Avenue, Student Services Bldg. 1st Floor • WEST 2201 Blue Gum Avenue, Yosemite Hall 1st Floor
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