ENROLLMENT VERIFICATION REQUEST FORM

You are requesting a verification. Please complete the following and submit:

Personal Information ,
Enrolled as: ,
Date of Birth:
School:
Campus:

Delivery Options

Please tell us how you wish your verification to be handled or delivered:


(Note: If you have selected delivery by mail, you will be asked to specify the address on the next page)

Number of copies for the selected delivery option:

Verification Options
It is the Rutgers University policy not to include the Social Security Number on enrollment verifications. If you think it necessary to have your Social Security Number print on your verification, please check the box below.
Include social security number on this verification document
Include GPA on this verification document

Please enter any comments or special instructions below:
Please do not use this box for entering mailing addresses!
You will be able to request a verification to be sent to a different address later.

Contact Information Please tell us how to contact you if we have questions about your request. Either your email address or phone number is required. (Note: If you supply your email address we will notify you when your verification is processed.)

Email Address:   Daytime Phone:


Attach Document

If you would like to attach a form to be sent along with your verification, please click "Yes" on the button below so that you can email the form before completing the ordering process. Thank you.