Fillable Enrollment Verification Release Of Information (Jackson State Community College)

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Enrollment Verification Release Of Information (Jackson State Community College)

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ENROLLMENT VERIFICATION REQUEST
(RELEASE OF INFORMATION REQUEST FORM)
Records Office y Jackson State Community College y 2046 North Parkway y Jackson, TN 38301
Fax (731) 425-2653 y Phone (731) 425-2654
9 Verification of enrollment request will not be honored until fees are paid or loan/financial aid
confirmation has been made for the requested semester.
9 We are unable to verify enrollment for future terms. (current & past terms only)
9 Please allow 2 to 5 working days for processing.
Verification needed for: Additional Request(s)/Comments:
______________________________________________
Year: __________ _______________________________________
Fall semester _______________________________________
Spring semester _______________________________________
Summer semester ______________________________________________
______________________________________________
I will pick up the completed letter or form(s)
Mail to: ________________________________________________________
(Name of Business)
____________________/____________________________________
(Office or Attention Person) (Address)
________________________________________________________
(City) (State) (Zip)
Fax please: _____________________________________________________
(Name of Attention Person or Business)
_____________________________________________________
(Fax number)
Anticipated Date of Graduation: _________________________________
(Month & Year of Expected Graduation)
Student Name: ________________________________________________
(Please print)
JSCC ID or SS#: _________________________ Date of Birth: _____________
Signature: ____________________________________ Date: _______________
(REQUIRED BY FEDERAL LAW)
By signing I authorize Records Office Personnel at Jackson State Community College to release
any information requested above.
RecordsOfficeuseonly:
Datereceived:_____________Dateprocessed:________________By:__________________
UpdatedMarch1,2010
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Enrollment Verification Release Of Information (Jackson State Community College)

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Completed 26 July 2020

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