Nwacc Enrollment Verification Form – Fill Out and Use This PDF

Processed By___________

Date__________________

Scanned By ____________

Date __________________

ENROLLMENT VERIFICATION RELEASE FORM

NorthWest Arkansas Community College

ID#____________________

SSN___________________ Name _________________________________________Date___________________

Current Adderess_______________________________________________________Phone__________________

Street or PO Box

__________________________________________________

Other names under which records could be listed [i.e. maiden name, married name(s), nicknames].

•Use a separate form for each request. Please type or print legibly.

•Financial obligations to NWACC must be satisfied before enrollment verifications maybe issued.

•Enrollment verifications can not be sent out until after the 11th day of classes.

CHECK THE APPROPRIATE ITEM(S) BELOW:

Mail Verification (enter address below)

Allow ONE WEEK for enrollment verifications to be issued.

Pick-Up Verification

Number of Verifications Requested

Requested Semester of Verification

CHECK THE TYPE OF VERIFICATION YOU ARE REQUESTING:

Early Enrollment Verification

General/Insurance Purposes

Other

SEND TO:

Send this request to the Student Records Office by one of these three methods:

Mail: NWACC Student Records Office,

One College Drive

Bentonville, AR 72712

Fax: (479) 619-2229

In person: The Student Records Office is located on the second floor of the Student Center.

Hours are Monday through Thursday from8:00 a.m. to 6:00 p.m. and Friday from9:00 a.m. to 4:30 p.m.

Exceptions to these hours are made during holidays.

No one else (including your spouse, parent, etc) may pick up your enrollment verification without your written permission. Identify by name the person whois authorized to obtain your Verification and include your original written signature.

Phone or e-mail requests are not accepted.