Fillable VERIFICATION OF ENROLLMENT FORM (Piedmont Virginia Community College)

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VERIFICATION OF ENROLLMENT FORM (Piedmont Virginia Community College)

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VERIFICATION OF ENROLLMENT FORM
By signing below, I authorize Piedmont Virginia Community College to release information
regarding my enrollment and student status.
Name (printed): __________________________________________
PVCC student ID#: _______________________________________
Phone number: __________________________________________
I am requesting verification of the following term/terms: ___________ (ex: Fall 2013)
Please send this information via the following manner:
I will pick-up
Fax to: Name _________________________________
Number _______________________________
Mail to:
_________________________________________________________
Name of Person or Company
_________________________________________________________
Address
_________________________________________________________
City, State, Zip Code
Any additional notes:
Signature: _________________________________Date:__________________
PLEASE ALLOW FIVE BUSINESS DAYS FOR PROCESSING
Revised 9/2013
Records Office Use Only:
Processed by: ____________
Date: _____________
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VERIFICATION OF ENROLLMENT FORM (Piedmont Virginia Community College)

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Completed 4 February 2021

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