OFFICE OF THE REGISTRAR
VERIFICATION OF DEGREE STATUS REQUEST FORM
STUDENT NAME
ID#
SSN
NUMBER & STREET
CITY
STATE
LOCAL/PERMANENT ADDRESS:
ZIP
PHONE#
EMAIL ADDRESS
VERIFICATION REQUIRED FOR
DEGREE EARNED
COMPLETION OF DEGREE REQUIREMENTS
IF VERIFICATION IS FOR DEGREE EARNED, INDICATE GRADUATION MONTH
IF VERIFICATION IS FOR DEGREE EARNED, INDICATE GRADUATION YEAR
IF VERIFICATION IS FOR COMPLETION OF DEGREE REQUIREMENTS (PRIOR TO GRADUATION), INDICATE ANTICIPATED GRADUATION MONTH
IF VERIFICATION IS FOR COMPLETION OF DEGREE REQUIREMENTS (PRIOR TO GRADUATION), INDICATE ANTICIPATED GRADUATION YEAR
PERSONAL IDENTIFIABLE INFORMATION REQUESTED ON VERIFICATION LETTER (PLEASE INDICATE):
LAST FOUR DIGITS OF SOCIAL SECURITY NUMBER
COMPLETE SOCIAL SECURITY NUMBER
OTHER
If Other
VERIFICATION LETTER IS TO BE
MAILED
FAXED
*I WILL PICK UP
*Requests designated for pick up that are not picked up after three (3) business days from the date of request was submitted will be destroyed and a new request will have to be submitted.
THIS LETTER SHOULD BE MAILED TO:
THIS LETTER SHOULD BE FAXED TO:
THIS LETTER WILL BE PICKED UP BY: (IDENTIFICATION WILL BE REQUIRED)
DATE OF REQUEST
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