STUDENT VERIFICATION REQUEST FORM
I. Student Information
1.
Student ID #:
2.
Legal Name:
First Name
Middle Name
Last Name
3.
Date of Birth:
(yyyy-mm-dd)
4.
Program:
❒ Bachelor of Arts in Liberal Arts ❒ Master of Arts in Buddhist Classics
❒ Translation Certificate Program
5.
Current Term:
❒ Fall ❒ Spring
❒ Summer
Year:
II. Verification Information
Verification of: (Mark all that apply.)
Other items to include: (Mark all that apply.)
❒
Enrollment for current/most recent semester
❒
Social Security Number (the last 4 digits)
❒
A specific semester of enrollment:
❒
Date of Birth
❒
Pre-enrollment for the upcoming semester*
❒
Graduation Date and Program
❒
Cumulative GPA
❒
Mailing Address
❒
Degree Conferred
❒
Residential Address
❒
Good Standing
❒
Other name(s) used
❒
Other
* Available only when the upcoming semester’s course schedule is published.
Delivery Instructions:
❒
Pick up by student or authorized personnel (written authorization required)
❒
Mail to:
❒
Fax to:
❒
Email to:
Date:
Student's Signature:
For Registrar/Records Office Use Only:
❒ Date processed _____________ ❒ Date mailed _____________ ❒ Date picked up _____________
Date: _________________ Received by: ________________________________________
Registrar - V3.0, 10/15/2024 Page 1 of 1