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  • State University of New York at Brockport ~ Office of Registration and Records
    350 New Campus Dr, Rakov Rm 201 Brockport, NY 14420-2966

    State University of New York at Brockport ~ Office of Registration and Records<br />
350 New Campus Dr, Rakov Rm 201 Brockport, NY 14420-2966
  • College seal and Registrar signature: School OPEID: 002841

    College seal and Registrar signature: 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

    The Student Information Section below this disclosure is to be PROVIDED ONLY by STUDENTS to request their enrollment verification.

  • *

  • Student Name Student Name *
  • 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 * / /
    Pick a date.
  • Your Permanent Mailing Address Your Permanent Mailing Address *
  • Provide Anticipated Date of Graduation (if already graduated use that date) Provide Anticipated Date of Graduation (if already graduated use that date) * / /
    Pick a date.
  • Draw or Type
    I understand this is a legal representation of my signature. Clear
  • delivery: you can list a place with their address or an email of where the document can be "E-delivered"

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350 New Campus Drive
Brockport, NY 14420