Fillable STUDENT INFORMATION Enrollment Verification Request (Wayne State University)

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STUDENT INFORMATION Enrollment Verification Request (Wayne State University)

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Office of the Registrar July 2011
Enrollment Verification Request
Mail/Fax to: Records and Registration Office
5057 Woodward, Fifth Floor
Detroit, MI 48202
Phone: (313) 577-3541
Fax: (313) 577-7870
Drop Off: Student Service Center Lobby
Welcome Center
42 W. Warren
Detroit, MI 48202
Phone: (313) 577-2100
Date: _______________________
STUDENT INFORMATION
PLEASE PRINT LEGIBLY
Student ID or SSN
Last Name First Name Middle
Previous Names
Birthdate MM/DD/YY
Daytime Phone
Please specify the service you are requesting:
Enrollment Verification
Loan Deferment
Change Anticipated Graduation Date
Please specify the term/year for which service is requested:
Winter / __________
Spring-Summer / __________
Fall / __________
Anticipated Graduation Date (mm/yyyy): If you are requesting enrollment verification or loan
deferment forms for future terms, the forms will not be
processed until the first official day of classes for that term.
Please specify pick-up or mailing preference:
Please mail the information:
Electronic Attachment
Fax to: _________________________________________________________________________
Pick Up (4 Business Days)
Envelope provided
Address for mailing: ______________________________________________________________
______________________________________________________________
______________________________________________________________
Additional Information and Instructions:
Student Signature X
Date
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STUDENT INFORMATION Enrollment Verification Request (Wayne State University)

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Completed 24 July 2020

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