Fillable VERIFICATION REQUEST FORM (Los Angeles Harbor College)

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VERIFICATION REQUEST FORM (Los Angeles Harbor College)

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The VERIFICATION REQUEST FORM (Los Angeles Harbor College) form is 1 page long and contains:

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Country of origin: US
File type: PDF

U.S.A. forms for Los Angeles Harbor College

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___________________
Notes for Business Office: _
VERIFICATION REQUEST FORM
Rush: Next business day- $10.00 Regular: – 7-10 Business Days - $3.00
Last Name First Name Middle
Student I.D. Number or SSN
Address
Date of Birth (MM/DD/YYY)
City State Zip Code
Phone Number
Maiden or Other Names
Email Address
Signature Today’s Date
_____________________________________ ________________
I understand that under the Family Educational Rights and Privacy Act (FERPA) of 1974, verification may not
be released without the written consent of the student. Verification will not be processed without student
signature.
I am requesting:
Verification of Enrollment:
Good Student Insurance Discount
Special Form to be Complete is attached
Verification of Non-enrollment
Semester to be verified:
Spring Summer Fall Winter Year: _________
Select type of processing service:
Regular
Rush
(Allow 7-10 business days)
(Picked up next business day)
I will pick up the verification.
Please mail/email this verification to:
Sent to: ________________________________________
Attn: ___________________________________________
Address: ________________________________________
City: _______________ State: ________ Zip: __________
For Office Use Only
Completed:
Pick up/Mail/Email
Date:
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VERIFICATION REQUEST FORM (Los Angeles Harbor College)

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Completed 6 January 2022

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