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Student Legal Name (required - type or print clearly): ___________________________________________________
Student Signature (required): __________________________________________________________________________
E Number (if available): _______________________________________________________________________________
Student Date of Birth (required): __________________________ Student phone # (optional) ___________________
This letter should indicate (fill out for which semester & year below): Example: Indicate “Spring”, “Summer” or “Fall”
Semester and the year, such as: Semester: Fall of Year: 2019 to request Fall Semester 2019 enrollment verified.
Up to two semesters of current or past enrollment may be requested with verification letters. If you need more
than two semesters you will need to order a transcript. We cannot verify enrollment in a future semester but we
can verify pre-registration in a future semester if the student has already pre-registered for that semester.
IMPORTANT: Enrollment verification is not available until after Count Day (the 10
th
class day of the semester). Pre-
Registration for full-time/¾-time/half-time/less than half-time is available before Count Day if student has pre-registered.
All requests for enrollment verification for an upcoming semester will be held until after that semester’s Count Day.
Please request enrollment verification and pre-registration for the same semester on separate forms as we will
have to hold the requests for enrollment verification until after Count Day.
Loan Deferment: Semester (Spring, Summer or Fall): _________________ of Year: ____________
(Available after 10
th
class day: Enrolled full-time/¾-time/half-time/less than half-time for the current semester or a past semester, dates of semester
and expected graduation date)
Enrollment Verification: Semester (Spring, Summer or Fall): _________________ of Year: ____________
(Available after 10
th
class day: Enrolled full-time/¾-time/half-time/less than half-time for the current semester or a past semester and dates of
semester)
Pre-Registration: Semester (Spring, Summer or Fall): _________________ of Year: ____________
(Available after student has pre-registered for an upcoming semester through the 10
th
class day: Pre-Registered full-time/¾-time/half-time/less than
half-time for a future semester and dates of semester)
Other: ______________________________________________________________________________________________
(such as requesting degrees awarded)
______________________________________________________________________________________________
How would you like your verification letter delivered? (NOTICE: Only dates of attendance, full or part-time
status or degrees earned can be e-mailed. No grades, GPA, enrolled hours or academic standing.)
Complete mailing address: ____________________________________________________
Please print clearly and include
name, street address or post office ____________________________________________________
box & city, state & zipcode.
____________________________________________________
____________________________________________________
Faxed to: Name: _______________________________________
Fax # (including area code): ____________________________
E-mailed to: ____________________________________________
Return completed and signed form to:
Office of the Registrar, Eastern Illinois University, 600 Lincoln Ave., Charleston, IL 61920-3099
Fax# 217-581-3412 E-mail: records@eiu.edu
