Verification Request Form

Eastern Illinois University

Student Name (print): ______________________________________________________________

Student Signature:  ________________________________________________________________

E-Number or Social Security Number:  _________________________________________________

This letter should indicate:

Loan Deferment:     ______                        

Full-Time attendance:                                                   Pre-Registration:

Specify which semester & year                                  Specify which semester & year

(Spring, Summer or Fall & year) :  ___________    (Spring, Summer or Fall & year) : ___________

Note:  Full-Time enrollment is not available until after Count Day (10 days after the beginning of the semester) for each semester.  Pre-Registration is available before Count Day if student has pre-registered.               

Other (explain):   __________________________________________________________________

                           __________________________________________________________________

How would you like your verification letter delivered?

Pick up in Office of the Registrar?     Yes:    _____                          

or:

Complete address for mailing:

      Name line 1:   __________________________________________ 

       Name line 2:  __________________________________________          

    Street Address:   __________________________________________

 City, State & Zip Code:   __________________________________________                                                           

or:

Faxed to attention of or company name:    ______________________________________________

Fax number (including area code):    _________________________________________________

Return completed and signed form to:

Office of the Registrar

Eastern Illinois University

600 Lincoln Ave.

Charleston, IL  61920-3099

Fax# 217-581-3412