Office Use Only: Completed By: _________Date Sent: _______
2/20/2020
Return this form to One-Stop Service Center (STE 230) or via Email: Enroll@uttyler.edu
Notice about Information Laws and Practices With few exceptions, you are entitled on your request to be informed about the information The University of Texas at Tyler collects about you. Under Sections 552.021 and
552.023 of the Texas Government Code, you are entitled to receive and review the information. Under Section 559.004 of the Texas Government Code, you are entitled to have The University of Texas at Tyler correct
information about you that is held by us and that is incorrect, in accordance with the procedures set forth in The University of Texas System Business Procedures Memorandum 32. The information that The University of
Texas at Tyler collects will be retained and maintained as required by Texas records retention laws (Section 441.180 et seq. of the Texas Government Code) and rules. Different types of information are kept for different
periods of time.
Letter of Non-Enrollment
Verification of Enrollment
*Please Check ONE Option
All forms of delivery, must allow
for 2-3 business days for
processing.
The University of Texas at Tyler
Request for Verification of Enrollment
Please Print All Information
Students seeking a Verification of Enrollment from The University of Texas at Tyler through the One-Stop Service Center
must complete this document and submit it along with a valid government or UT Tyler-issued photo ID. If additional
documents must be completed and returned (e.g. Loan Deferment from a specific lender and insurance purposes), all such
documents must be included with this form at the time of submission.
Please note that verification of enrollment is available only after the official Census Date of each session. All Census Date
information is listed on the UT Tyler Academic Calendar: https://www.uttyler.edu/academics/academic-calendar.php
).
Note: UT Tyler provides enrollment data to the National Student Clearinghouse several times each term,
beginning after the Census Date. This data can be confirmed by third party requestors for verification of
enrollment or loan deferment purposes.
Name: _____________________________________________________________________
(Last) (Middle) (First)
Student ID Number: ________________________ Phone Number: ______________________________
Email Address: _________________________________________________________________________
Semester and Year to be verified: ___________________________________________________________
(Ex. Spring 2014; Summer 2016)
Intended Recipient: _______________________________________________________________________
Delivery Address: _________________________________________________________________________
_________________________________________________________________________________________
_________________________________________________________________________________________
Email Address: ___________________________________________________________________________
Fax Number: ___________________________________
By my signature below I verify that I have read and understand all information provided by UT Tyler on this document
and that all information I have provided is accurate.
Signature: ________________________________________ Date: ________________________________
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