PLEASE SUBMIT A SEPARATE FORM FOR EACH REQUEST. PRINT LEGIBLY IN BLACK OR BLUE INK.
Student ID Number
Or Last 4 digits of SSN
Date of Birth
Last
Name
First
Name
Middle
Initial
Other
Names
Verify Enrollment For:
Term (ex: Fall 2017) __________________________
In addition to my name, please include the following information:
My Social Security Number:
Enclosed Form
Expected graduation date, which is:
Other:
CHECK t
he appropriate box Note: You will be called when document is ready for pick up.
Mail Enrollment Verification to address listed below:
Is this your home address? Yes No If Yes, we will update your records
We are unable to process your verification request for the following reason:
Financial Obligation 321-433-7615 for assistance
Library Obligation 321-433-7250 for assistance
Other
Please re-submit your request after you have satisfied your obligation to the college.
Name/Institution/Agency:
Attention to/ Room #
Address
City/State/Zip
REQUEST FOR
ENROLLMENT VERIFICATION
SC-221 R101117
Please allow 3 business days after receipt of request for processing. Enrollment verifictions will not be processed until after the add/drop date, so
that may add additional processing time. Information will be reported based on your academic record as of the date prepared.
Military ID Insurance
All Terms (Enrollment History)
Purpose: Select all that apply
Name/Institution/Agency
Attention to / Room #
Address
City/State/Zip
I will return to pick up the Enrollment Verification. (Photo ID required)
Optional 3rd Party Pick-up: I authorize the person named below to pick up enrollment verification (Photo ID required)
________________________________________________________________________________________________
THIS REQUEST WILL NOT BE PROCESSED IF NOT COMPLETE OR IS NOT SIGNED.
PHOTO IDENTIFICATION MUST ACCOMPANY THIS FORM IF MAILED, FAXED OR EMAILED.
Daytime Phone number:_____________________________________________
Signature:____________________________________________________________ Date:________________________
Verification that I never attended EFSC
International/Embassy (Mailed directly to embassy)
Other (Please explain) ____________________________________________________________________________
click to sign
signature
click to edit
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