Student Verification Request Form
ADVERTISEMENT
1VERFICATION REQUEST FORM
Name _______________________________________________________
Student ID# __________________
Last
First
Middle
Former Names
(or SSN)
Date of Birth _______________ Daytime Phone (_____)_____-__________
Mail or Fax to:
Dept/Company Name ___________________________________________________________
Person’s Attention
___________________________________________________________
Street Address or Fax# ___________________________________________________________
City ____________________ State _____ Zip _______________
Type of Verification:
Special instructions:
(Check any that apply)
(Check any that apply)
_____ Verification of current enrollment.
_____ Add parent(s) name(s):__________________
_____ Verification of past term enrollment:_______________ _____ Include acct, policy or ID#:______________
Semester(s)/Year(s)
_____ Verification of academic standing (Good student discount).
_____ Include my Social Security #:____________
_____ Verification of graduation.
_____ Please complete attached form.
_____ Other:________________________________________
_____ Other:_______________________________
Reason for Verification:
(Check any that apply)
_____ Loan Deferment
_____ Health Insurance
_____ Car Insurance
_____ Scholarship
_____ Personal
_____ Military
_____ Other:____________________________________________________________
I affirm that I am the above-named student. In compliance with FERPA, I hereby give my written consent and
authorize Capital University to release my student record as noted.
Signature _____________________________________________ Date _______________
NOTE: 1)
Although it can vary, it generally takes five business days from the date we receive a
request to the date we mail/fax our response.
2)
Your date of birth will show on your request. Loan deferments and verifications for
the military will show your social security number (SSN). If you would like your SSN
listed, please indicate this on your request.
3)
Student signature is required when releasing SSN, academic standing information or
when student has a request on record to prevent disclosure of information (FERPA).
4)
Please have your picture ID with you when visiting the Office of the Registrar.
For Office Use Only:
______________
Date Received
ADVERTISEMENT
0 votes
Related Articles
Related forms
Related Categories
Parent category: Business