OFFICE OF THE REGISTRAR
MSC 105, 1050 W. SANTA GERTRUDIS AVE
KINGSVILLE, TEXAS 78363-8202
PH (361) 593-2811 * FAX (361) 593-2195
www.tamuk.edu
Check One:
Are you a graduating senior for the CURRENT SEMESTER? Yes _____ No _____
Last Name First Name Middle Name
__________________________________________ ____________________________________
Student K ID# or Social Security Number (SS#) Telephone # (Including area code)
__________________________________________________________________________________________
Current Mailing Address City State Zip Code
__________________________________________ ____________________________________
Student Signature Date
Office of the Registrar’s Use Only: Date Marked: _______________ Processed By: ___________________
Date Picked up: _____________ Processed By: ___________________
Date Mailed: ________________ Processed By: ___________________
Date Revised 11/23/15
Date Faxed: _________________ Processed By: ___________________
ENROLLMENT VERIFICATION REQUEST FORM
SEMESTER(S) TO BE VERIFIED: ______________ / _______________ / __________________
Number of copies needed: _______
I will pick up verification.
To be picked up by someone other than student. _____________________________________________
(PLEASE PRINT FULL NAME)
NOTE: Any person picking up verification must present a valid picture ID.
Mail to: _____________________________________________________________________________
_____________________________________________________________________________
_____________________________________________________________________________
Fax to: ( ) _________________________________________________________________________
ADDITIONAL INFORMATION FOR FAX COVER SHEET:
_____________________________________________________________________________
_____________________________________________________________________________
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