Fillable PVC ENROLLMENT VERIFICATION (Palo Verde College)

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PVC ENROLLMENT VERIFICATION (Palo Verde College)

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PVC ENROLLMENT VERIFICATION
PRINTOUTTHISFORMANDBRINGORMAILTOCAMPUS
STUDENTINFORMATION
CURRENTNAME______________________________________________________ SSN/STUDENT ID ___________________
Last FirstMiddle
OTHERNAMESUSEDATPVC __________________________________________ BIRTHDATE________________________
CONTACT PHONENUMBERorEMAIL ADDRESS_______________________________________________________________
DELIVERYINFORMATION
Mark ONE ofthefollowingdeliveryoptions
(Aseparate EnrollmentVerification isrequiredforeach
option):
□ Mail (complete mailinginformation)
□ Pickup (destroyedafter 3weeks ifnotpickedup)
Completeif Mail wasmarked(Verificationswillbemailed exactly aswrittenbelow):
Name (person or institution) _____________________________________________
Attention(personordepartment) _________________________________________
Address _________________________________________________________
City________________________________State______Zip____________
ORDERINFORMATION:NumberofCopies:_____
Verificationswilltake23businessdaystocomplete
ADDITIONALINFORMATION:
□ Termverificationfor: □ Summer20___ □ Fall 20___ □ Spring 20___
□ Includefee/payment information □ IncludeGradePointAverage(GPA)
NOTE:
· EnrollmentVerifications maynotberequestedor releasedoverthecounterwithoutvalidPhotoI.D. Ifrequestedbyathird
party,th eremustbe writtenauthorizationfromthestudent witha copyofthe student’sI.D.,andthethirdparty musthavea
validPhoto I.D.
· Verificationswillnotbereleaseduntilallfinan cialobligationstothecollegehavebeenpaid.
STUDENTSIGNATURE_______________________________________________________________DATE_______________
Palo Verde CollegeCampus
Registrars Office
One College Drive
Blythe,CA922
25
(760) 921-5500
OFFICEUSE: Receivedby______ Date__________
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PVC ENROLLMENT VERIFICATION (Palo Verde College)

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Completed 5 September 2020

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