FAX: (908) 709-7131 PHONE: (908) 709-7134/7123
* IF YOU HAVE FINANCIAL OBLIGATIONS AT UNION COUNTY COLLEGE, THIS REQUEST WILL NOT BE
PROCESSED, YOU MUST CLEAR YOUR OBLIGATION AND SUBMIT A NEW REQUEST.
NAME ____________________________________________________ SID# _________________________________
PLEASE PRINT STUDENT ID#
PLEASE INDICATE THE TERM AND YOUR TIME STATUS FOR THE REQUESTED SEMESTER(S) YOU NEED
VERIFIED. YOUR REQUEST WILL BE REVIEWED, PROCESSED AND COMPLETED WITHIN 2 BUSINESS DAYS.
FALL ___ WINTER SESSION ___ SPRING ___ SUMMER I ___ SUMMER II ___ ENROLLMENT HISTORY ___
YEAR YEAR YEAR YEAR YEAR (EVERY SEMESTER)
FULL-TIME [ ] HALF-TIME [ ] PART-TIME [ ]
(12 or more credits) (6-11 credits) (5 or fewer credits)
[ ] I am requesting a letter [ ] I do need a school seal [ ] I do need a signature
[ ] I have attached a form (Please fill out your area of the form and sign if required).
[ ] Other Request: ________________________________________________________________
Please complete the mailing address ONLY if you want your request mailed, or list fax number or pick up date.
[ ] Mail to: _____________________________________________________________________
_____________________________________________________________________
_____________________________________________________________________
[ ] Fax: _____________________________________________
[ ] Pick up the letter: _____________________________ (Allow 2 business days)
list date
I HEREBY AUTHORIZE UNION COUNTY COLLEGE TO RELEASE THE ABOVE REQUESTED
ENROLLMENT INFORMATION.
I give ____________________________________ permission to pick up my enrollment verification
PRINT NAME
letter, because I will not be able to pick this form up. ______ ______
Initials Date
________________________________________________________ ________________
STUDENT’S SIGNATURE DATE
Rev. 01/17
REQUEST FOR STUDENT VERIFICATION FORM
(908) 709-7000
_________________________________
Union County College Authorized Initials
__________________
Date
Union County College does not discriminate and prohibits discrimination, as required
by state and/or federal law, in all programs and activities, including employment and
access to its career and technical programs.
click to sign
signature
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signature
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