Enrollment Verification Form

Student Number

Student Name

Student Email Address

How many copies/certication(s) of enrollment do you need?

How would you like to receive your copies? Please select and option and complete the necessary info for that option

Mailed

Emailed

Mailing Address (if you selected the Mailed option)

E-mail address (if you selected the e-mailed option)

Please check one of the following:

I am not a VA Student.

I am a VA student and I understand that the enrollment verification provided by the Registrar's office does not satisfy enrollment verification requirements for Veteran's Affairs purposes, and that I must contact my VA Certifying Official at Coastal Alabama Community College to certify my enrollment to Veteran's Affairs.

Special Notes: (ex: Anticipated graduation date, policy number, etc...)

Student Signature

Checking this box indicates my signature

Date

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