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Office of the Registrar
REQUEST FOR ENROLLMENT VERIFICATION
Last Name ________________________________________________________________ First Name __________________________________________________
Please print clearly
CUNY FIRST ID #
NOTE: The College does not give official letters to students. If you want the certification letter to be official,
the College must mail it directly to the agency requesting the information.
MAIL TO:
Name ___________________________________________________________________________________________________________________________________
Address _________________________________________________________________________________________________________________________________
City __________________________________________________________________________ State ________________ Zip _______________________________
PURPOSE OF LETTER: ____________________________________________________________________________________________________________
PLEASE NOTE: if this verification letter is being sent for health insurance purposes please include the primary
policy holder’s name and ID number or your insurance may be denied.
Primary Policy Holder’s Name _____________________________________________________________________________________________________________
Primary Policy Holder’s ID # _________________________________________________________________________
Indicate below semester verifying:
SPRING SUMMER FALL
Please mark the type of letter you want below:
ENROLLED: The information provided will include your name, student CUNY First I.D. number full or
part-time status, number of progress units per semester earned, current program of study and your
anticipated date of graduation.
GRADUATION STATUS: The information provided will include your name, CUNY First student I.D. number,
graduation dates, the degrees and/or certificates received.
DEPT. OF LABOR (UNEMPLOYMENT BENEFITS): The information provided will include your name,
student CUNY First I.D. number, a semester schedule and your anticipated date of graduation.
ADDITIONAL INFORMATION:
____________________________________________________________________________________________________
I request that Queensborough Community College release the information noted on this application to the
Agency/individual identified above:
Student Signature ____________________________________________________________________________________ Date _______________________________
12/2016 307-17
