Verification Request Form - Eastern Illinois University

Student Name (print): ______________________________________________________________

Student Signature:  ________________________________________________________________

E-Number or Social Security Number:  _________________________________________________

This letter should indicate - Fill out for which semster & year below:
(Example: Fall 2008, Spring 2009, etc. Two semesters of current or past enrollment may be requested with this form. We cannot verify enrollment for a future semester. If you need more than two semesters verified, you will need to order a transcript.)

IMPORTANT:  Full-Time enrollment is not available until after Count Day (Count Day is the 10th class day of the semester).  Pre-Registration is available before Count Day if student has pre-registered. All requests for full-time enrollment for an upcoming semester will be held until after that semester's Count Day.
***Please request full-time enrollment and pre-registration for the same semester on separate forms as we will have to hold the requests for full-time enrollment until after Count Day.

Loan Deferment: (term/year) _________________________________________

Full-time Enrollment: (term/year) ______________________________________

Pre-Registration: (term/year) _________________________________________

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:   __________________________________________                                                         

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