Jackson State University
Office of A
Verification of Enrollment
Receipt of Syllabus
(Actual enrollment in this course can only be validated by the Registrar.)
Please complete the information requested below
and return this form to the instructor.
Name: __________________________ J-Number: ________________
Course No./Section______________ Course Title: ________________________
Semester: _____________ Year: _______________
By checking the box and entering my date of birth, I acknowledge the receipt of a syllabus
for the above course.
Electronic Signature (Date of Birth)
Note: Type in this form (Adobe Reader
required to save form.) SAVE the
COMPLETED form with your
firstname_lastname on your computer.
Send or attach the file according to your