Enrollment Verification Request

ENROLLMENT VERIFICATION REQUEST

Instructions: Complete form and submit to Admissions Office. Return to Admissions to pick-up the

Enrollment Verification after the third week of the term.

The National Student Clearinghouse is Southern Crescent Tech’s authorized agent for providing degree

and enrollment verifications. Companies may contact the National Student Clearinghouse at

(or directly at ).

Loan deferment forms and some other verification forms will be mailed to the National Student

Clearinghouse.

Date:___________________

ID#:______________________Term/Year:_________________________

Student Name:_________________________________________________________________________

Program:______________________________________________________________________________

Student Signature:___________________________________________

Date:_____________________

ENROLLMENT VERIFICATIONS WILL NOT BE MAILED. PICK-UP ONLY!

As set forth in full in its Course Catalog/Student Handbook, Southern Crescent Technical College is an Equal Opportunity Ins tu on and does not discriminate on the basis of race, color, creed, na onal

or ethnic origin, gender, religion, disability, age, poli cal affilia on or belief, gene c informa on, disabled veteran, veteran of the Vietnam Era, or ci zenship status (except in those special

circumstances permi ed or mandated by law). The following persons have been designated to handle inquiries regarding the non‐discrimina on policies: Title IX/Equity Coordinator (Griffin Campus,

Bu s County Center, Henry County Center, and the Jasper County Center) Toni Doaty, Griffin Campus, Room 303, 501 Varsity Road, Griffin, GA 30223, (770)228‐7382, tdoaty@sctech.edu; ADA/Sec on

504 Coordinator (Griffin Campus, Bu s County Center, Henry County Center, and the Jasper County Center) Teresa Brooks, Griffin Campus, Room 303, 501 Varsity Road, Griffin, GA 30223, (770)228‐

7258, tbrooks@sctech.edu; Title IX/Equity and ADA/Sec on 504 Coordinator (Flint River Campus and Taylor County Center) Mary Jackson, Thomaston Campus, Room 252A, 1533 Highway 19 South,

Thomaston, GA 30286, (706)646-6224, mjackson@sctech.edu. Any complaints filed against the Title IX/ Equity Coordinator or ADA/Section 504 Coordinator on any campus/center shall be handled by

Xenia Johns, Griffin Campus, Room 700, 501 Varsity Road, Griffin, GA 30223, (770)228-7348, xjohns@sctech.edu.

Revised: 7/26/2014

For Office Use:

ID Checked:_____

Printed _____/_____/_____

Initials:_____

ENROLLMENT VERIFICATION REQUEST

Instructions: Complete form and submit to Admissions Office. Return to Admissions to pick-up the

Enrollment Verification after the third week of the term.

The National Student Clearinghouse is Southern Crescent Tech’s authorized agent for providing degree

and enrollment verifications. Companies may contact the National Student Clearinghouse at

(or directly at ).

Loan deferment forms and some other verification forms will be mailed to the National Student

Clearinghouse.

Date:_______________

ID#:_____________________ Term/Year:____________________________

Student Name:_________________________________________________________________________

Program:______________________________________________________________________________

Student Signature:__________________________________________

Date:______________________

ENROLLMENT VERIFICATIONS WILL NOT BE MAILED. PICK-UP ONLY!

As set forth in full in its Course Catalog/Student Handbook, Southern Crescent Technical College is an Equal Opportunity Ins tu on and does not discriminate on the basis of race, color, creed, na onal

or ethnic origin, gender, religion, disability, age, poli cal affilia on or belief, gene c informa on, disabled veteran, veteran of the Vietnam Era, or ci zenship status (except in those special circumstanc‐

es permi ed or mandated by law). The following persons have been designated to handle inquiries regarding the non‐discrimina on policies: Title IX/Equity Coordinator (Griffin Campus, Bu s County

Center, Henry County Center, and the Jasper County Center) Toni Doaty, Griffin Campus, Room 303, 501 Varsity Road, Griffin, GA 30223, (770)228‐7382, tdoaty@sctech.edu; ADA/Sec on 504 Coordi‐

nator (Griffin Campus, Bu s County Center, Henry County Center, and the Jasper County Center) Teresa Brooks, Griffin Campus, Room 303, 501 Varsity Road, Griffin, GA 30223, (770)228‐7258,

tbrooks@sctech.edu; Title IX/Equity and ADA/Sec on 504 Coordinator (Flint River Campus and Taylor County Center) Mary Jackson, Thomaston Campus, Room 252A, 1533 Highway 19 South,

Thomaston, GA 30286, (706)646-6224, mjackson@sctech.edu. Any complaints filed against the Title IX/ Equity Coordinator or ADA/Section 504 Coordinator on any campus/center shall be handled by

Xenia Johns, Griffin Campus, Room 700, 501 Varsity Road, Griffin, GA 30223, (770)228-7348, xjohns@sctech.edu.

For Office Use:

ID Checked:_____

Printed _____/_____/_____

Initials:_____