Fillable VERIFICATION OF ENROLLMENT FORM (State University of New York College at Brockport)

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VERIFICATION OF ENROLLMENT FORM (State University of New York College at Brockport)

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BROWSE STATE UNIVERSITY OF NEW YORK COLLEGE AT BROCKPORT FORMS

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______________________________________________________________________________
______________________________________________________________________________
__________________________________________________________________________________________
__________________________________________________________________________________________
The College at Brockport
State University of New York
Office of Registration and Records
VERIFICATION OF ENROLLMENT FORM
350 New Campus Drive
Office of Registration and Records
Brockport, New York 14420-2966
Phone: (585) 395-2531
Fax: (585) 395-5392
Email: registrar@brockport.edu
PLEASE FILL IN COMPLETELY.
NAME: ________________________________________________ Banner ID:_______________________________
ADDRESS: ____________________________________________ DATE OF BIRTH: _________________________
_____________________________________________ TODAY’S DATE: __________________________
STUDENT SIGNATURE:____________________________________________________________________________
Please send this verification of my enrollment to the following agency checked below:
____ ACS, Utica NY ____ Student Loan Corporation (Citibank)
____ AES Loan Services ____ Student Loan Servicing Center, Rensselaer, NY
____ Great Lakes Higher Education Corp. ____ Wachovia
____ HSBC Bank USA ____ William D. Ford, Direct Loan Servicing Ctr.
____ Nelnet ____ Xpress Loan Services
____ Sallie Mae Servicing Corp., Wilkes-Barre, PA
OTHER:_____________________________________________________________________________
I request that the Registration and Records Office verify my enrollment for:
____ FALL ____ SPRING ____ SUMMER YEAR(S): 19________ Graduation Date/:___________________
20________ or Last Day of Attendance: __________
____ Full Time (12 crs. Or more) ____ Half Time (6-11 credit hours) ____ Less than Half Time _____ # of cr. hrs.
THIS SECTION WILL BE COMPLETED BY THE REGISTRATION AND RECORDS OFFICE
The student is/was enrolled during the academic period from:
____________________TO______________________ ___ Full-Time ___ Half-Time ___ Less than Half-Time
____________________TO______________________ ___ Full-Time ___ Half-Time ___ Less than Half-Time
____________________TO______________________ ___ Full-Time ___ Half-Time ___ Less than Half-Time
____________________TO______________________ ___ Full-Time ___ Half-Time ___ Less than Half-Time
____________________TO______________________ ___ Full-Time ___ Half-Time ___ Less than Half-Time
____________________TO______________________ ___ Full-Time ___ Half-Time ___ Less than Half-Time
Other Verification:__________________________________________________________________________
College Seal & Registrar’s Signature School OPEID # 002841
This verification was done by: _______________
Date: _______________
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VERIFICATION OF ENROLLMENT FORM (State University of New York College at Brockport)

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Completed 27 August 2020

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