Enrollment Verification Form

Full Legal Name:*

Campus ID #:*

Last 4 digits of SSN:

Date of Birth:*

Name while enrolled:*

Expected Graduation Date:*

Term to be Verified:

Email Address:*

Current Phone:*

How would you like to receive Verification?

Fax Verification

Mail Verification

If Fax Verification

List the Attention Field:

If Fax Verification

List the Note Field:

If Fax Verification

List the Fax Number:

If Mail Verification

List the Name Field:

If Mail Verification

List the Address 1:

If Mail Verification

List the Address 2:

If Mail Verification

List the City, State, Zip:

Date*

I Certify*

That this information is complete and correct to the best of my knowledge. I authorize the university to verify the information I have provided. I understand that submission of false information is grounds for withdrawal, cancellation of enrollment, and/or disciplinary action.

Who Are You?

Enrollment Verification Form

Angelo State University

Who Are You?

Enrollment Verification Form

Angelo State University

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