Enrollment Verification Request Form - White Mountains Community College

Requests will be processed within 1-3 business days, and emailed to the address provided unless indicated otherwise.

Name(Required)

First Last

Student ID #

Date of Birth(Required)

Email(Required)

Program/Major(Required)

Requests will be emailed to the address listed unless indicated below:

I request that my verification be emailed directly to me:(Required)

Yes

No: Please mail to address and recipient listed below:

Name: Only Complete if you would like a paper copy mailed

First Last

Address: Only complete if you would like a paper copy mailed

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

I am requesting enrollment verification for:(Required)

Fall Semester

Spring Semester

Summer Semester

I am taking courses at another CCSNH school through a Consortium Agreement:(Required)

Yes

Reason for Request:

Signature(Required)