Verification Form (102022)

INSTRUCTIONS FOR EXPEDITED REQUESTS

(Otherwise, complete and submit this form)
1) Log into WEB BANNER, 2) Select Sudent Services, 3) Select Registration, 4) Select Enrollment Verification Request (that's provided by the National Student Clearinghouse)

*** THE EXPEDITED OPTION IS A SUBSTITUTE FOR THIS FORM ***
School OPEID: 002841

State University of New York at Brockport ~ Office of Registration and Records
350 New Campus Dr, Rakov Rm 201 Brockport, NY 14420-2966
E N R O L L M E N T -- V E R I F I C A T I O N -- R E Q U E S T -- S E C T I O N

The Student Information Section below this disclosure is to be PROVIDED ONLY by STUDENTS to request their enrollment verification.
List major here if needed on verification:
Verification Type
go to this link for Degree Verifications
Student Name Student Name First Last
Student ID Number
Minimum of 9 digits required. Currently Entered: 0 digits.
contact admissions, student accounts, financial aid or registration if you do not have your ID#. Your number can be found on your bill.
Date of Birth Date of Birth / MM / DD YYYY
Your Permanent Mailing Address Your Permanent Mailing Address
Street Address Address Line 2 City State / Province / Region Postal / Zip Code Country
Provide Your Student/Personal Email
Semester/Session/Term to Verify
If other semester/sesssion/term Indicate year
Enrollment Status
Show anticipated graduation date for recipient on your verification
Provide Anticipated Date of Graduation (if already graduated use that date) Provide Anticipated Date of Graduation (if already graduated use that date) / MM / DD YYYY
Other delivery information - email fax or address where to send document

delivery: you can list a place with their address or an email of where the document can be "E-delivered"
Attach pdf if another form needs to be completed
maximum 5 files whose total size may not be more than 10MB
filenames should not contain more than one period (.)
Type your full name into the box below as legal representation of your signature.

INSTRUCTIONS FOR EXPEDITED REQUESTS

School OPEID: 002841

E N R O L L M E N T -- V E R I F I C A T I O N -- R E Q U E S T -- S E C T I O N