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