Registrars Office
Enrollment Verifcation
Please complete this form, sign, date and mail to: Manchester Community College, Registrar’s Office, Great Path, MS #13, P.O. Box 1046, Manchester, CT 06045-1046
or fax this form to 860-512-3221.
Your request will be forwarded to the National Student Clearinghouse for processing.Allow 10 working days for processing and mailing, except at the beginning and end of the
semester, when up to 15-20 days may be required. Enrollment Verifications are not processed until two weeks after classes begin.
STUDENT INFORMATION
First Name MI Last Name
Mailing Address Banner ID Number
City State Zip
Home Phone Cell Phone Work Phone
Email Address
Date of Birth
ENROLLMENT INFORMATION
Send information to:
Verify the following information:
Enrollment Dates
Semester from: to
Anticipated Graduation Date
Matriculation
SIGNATURE
Student Signature Date
January 2019/PR
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