Student Service Request Form

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8618 Westw ood Cent er Drive Suite 100
Vienna, Virginia 22182
Phone: +1 (571) 633-9651
Fax: +1 (703)
Student Service Request Form
Date: _________________
Student Name: ____________________________________________________________________________________
First Name
Last Name
Middle Initial
Student I.D. ___________________ Program:_____________________________________________
Address ____________________________________________________________________________________________
City ______________________________________________________ State____________ Zip-code_____________
Contact Number (_____) _______________________________
E-mail Address ________________________________________
Please Check Letter Requested:
□
Enrollment Letter (currently enrolled)
□
Course Letter (includes current courses)
□
Address Verification (verifying address in student record)
□
Degree Verification Letter (verifies degree(s) earned)-(UoNA-only)
(Please note: It is the responsibility of the student to keep his/her address current with the
University).
________________________________________________________________________________________________________________
Student’s Signature
Date
Please indicate how you will receive letter:
□
□
Pick-up
Postal Service
*International Postal Charges will apply
*Please Note: All letters will be completed within a 48 hour period. You will be emailed when
letter is ready for pickup.
Form v11.7.2008

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