Registration & Records Office
Student Verification Request
Please verify my status for:
___ Full Time ___ Insurance ___ Graduation
Name: Date:
Student ID:
I authorize Rockland Community College to include my Social Security Number in the
___ Yes ___ No Signature:
(If you check NO, you are acknowledging that your SS# will not be included in the verification and your
information may not be sufficient for the third party)
Semester: __ Spring __ Fall Year: 20___
I would like number of copies
I would like my letter to be:
Picked up in one week: ___
Mailed to: ___
Faxed to: ___
To include the following additional information: