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.
First Name MI Last Name
Mailing Address Banner ID Number
City State Zip
Home Phone Cell Phone Work Phone
Date of Birth
Send information to:
Verify the following information:
Semester from: to
Anticipated Graduation Date
Student Signature Date