Rev. 09/13
Request for Enrollment Verification*
*Use this form only when the party requesting verification does NOT have a verification form
Deferment, Insurance, and Lender enrollment verification forms should be sent to the Registrar’s Office
at the address noted at the bottom of this page.
Student Name: ________________________________________________________________
First Middle Last
Student ID#: ______________ Student Email: _________________ BVU Location: ________
Please check the reason your enrollment information is being requested:
Child Care Insurance Military Reimbursement
Scholarship Unemployment
Send Verification to one of the following: (Please provide complete mailing address or fax number or
email address. Please be sure to indicate the name of the party receiving the verification.)
Special instructions: ____________________________________________________________
Signature: ____________________________________________________________________
Signature REQUIRED*
*In accordance with the Federal Family Educational Rights and Privacy Act (FERPA), a student’s educational records cannot be
disclosed without prior written consent of the student. Requests submitted without a signature cannot be processed.
Return completed form to the Registrar’s Office
BVU, Office of the Registrar, 610 W. Fourth Street, Campus Box 2009, Storm Lake, IA 50588 • 712.749.2233 • Fax: 712.749.1466
Please select: SL Campus semester
Fall Interim Spring
GPS Term: 1 2 3 4 5 6