Scanned By ____________
ENROLLMENT VERIFICATION RELEASE FORM
NorthWest Arkansas Community College
One College Drive Bentonville, AR
72712 (479) 636-9222
SSN___________________ Name _________________________________________Date___________________
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.
Number of Verifications Requested
Requested Semester of Verification
CHECK THE TYPE OF VERIFICATION YOU ARE REQUESTING:
Early Enrollment Verification
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.