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Verification Request

    * Indicates required fields

   Last Name *

 

   First Name*

 

   Middle Name  

 

 ND I.D. *

 Date*

   

 #of Copies *

  

 

*VERIFICATION CATEGORY    

 

Please verify my current enrollment for:            Fall         Spring       Summer

 

OR

 

Please verify that I have registered for a future term but have not yet enrolled:

                                                                                                 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:

 

CURRENT CLASS SCHEDULE

 

STUDENT SIGNATURE: ________________________________________  DATE: __________________

 

*DELIVERY METHOD:

 

PICK UP                 DESIRED PICK-UP DATE: 

 

MAIL TO:

NAME:      

ADDRESS:

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.  If the student’s signature is required, please sign and submit to the Office of the Registrar, 105 Main Building, 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) 631-5997.

 

Verifications are normally completed for pick-up or mailing in one or two business days from the time requested. However, at the beginning of the Fall and Spring semesters, the completion time will be longer.  For additional information regarding verifications, please visit http://registrar.nd.edu/verifications.shtml or e-mail the Office of the Registrar.