Clarion University of Pennsylvania
REQUEST FOR ENROLLMENT VERIFICATION
(This form is used to verify a student's current or past enrollment dates & expected date of graduation at Clarion University.)
Return completed form to:
Registrar's Office
122 Carrier Administration
840 Wood Street, Clarion, PA 16214
Fax: 814-393-2039
During the first week of classes, please allow at least one full business day for processing due to the large volume of forms
being processed.
Your enrollment verification may be taken with you, mailed, or faxed. Please allow a few minutes for processing if you want to take
your verification with you.
Please print legibly:
Name Clarion ID
Daytime Phone
Place a check mark in the box next to the information you wish to be verified.
Current semester enrollment only
Future semester enrollment
All dates of attendance
Anticipated date of graduation
Degree verification (date degree was completed is required)
(Month/Year)
(Month/Year)
Please provide policy holder information (insurance purposes) if it needs to be included in your enrollment verification:
Please mail the enrollment verification to this address:
Same day pick-up (except for 1st week of classes)
Method of Delivery:
(If mailing home, please include parent(s) name)
Please fax the enrollment verification to this number:
ATTN:
Student's Signature Date
Office of the Registrar - Clarion University of Pennsylvania 8/2009
