Verification Request

Student Information
Verification Category Please verify my current status for:FallSpringSummer

OR

Please verify that I have registered for a future term but have not yet completed the ND Roll Call process: Fall Spring Summer

OR

I am not currently a student; please verify my dates of attendance or graduation.

Last Date of Attendance or Date of Graduation:
*PLEASE INCLUDE THE FOLLOWING INFORMATION: Degree Earned

Signature of the student is required to verify the following information:

Degree Earned

STUDENT SIGNATURE: ________________________________________

DATE: __________________

Delivery Method PICK UP

DESIRED PICK-UP DATE:


MAIL TO:

NAME:

ADDRESS:

CITY: STATE: ZIP:


FAX TO:

FAX: () - ATTN:

 

 Use the following fields only if verification will be mailed or faxed directly to insurance company

Parent Name:

Group/Member Number:

Please print this form, sign and submit it to the Office of the Registrar, 300 Grace Hall, Notre Dame, IN 46556, or fax to: (574) 631-3865. If you have additional questions regarding this form, please contact the Office of the Registrar at (574) 631-7043. A printed grade report will not be processed without a signature.

Student Signature: __________________________________________________

Date: ___________

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