Academic Verification Form

Return To:
Verification Department
Address:
Fax:

mm/dd/yyyy

Student Name:

University ID:

or SSN:

The following information below will be verified:

Name
Enrollment status
Date(s) of attendance-past, current, future
Major(s
Degree(s) conferred

Note: The academic verification reports all completed or in progress degree programs. Other academic program notations including minors, options, certificates and non-credit programs are reported on the student's official academic transcript.

*Verification Fees/Payment:

Verification Fee $6 X

$ Verification Total

Special Service: (Noon Cutoff Eastern Time)

$30 Federal Express Delivery

$ Total Amount Due

Current enrolled degree(s)
Expected date of graduation
Date of birth (month and day)
Permanent residence and local address
Good standing statement

**Payment:

	Check (Enclosed, Payable to University)
	Credit Card (Visa, MasterCard, Discover or American Express)

Credit Card Number:

Expiration Date:

Daytime Phone Number:

E-mail Address:

Address where academic verification is to be mailed:

Name:

Street 1:

Street 2:

City/State/Zip:

Requestor Signature:

Date:

Note: We do not include University ID or Social Security number on the verification.

* Currently enrolled students will not be charged a fee for an academic verification, however, the student will be responsible for special service fees if requested.

** Any request received from a third party or a former student that does not have payment enclosed or credit card information list ed, will not be processed, and will be returned to the sender.