FLORIDA AGRICULTURAL & MECHANICAL UNIVERSITY

							FLORIDA AGRICULTURAL & MECHANICAL UNIVERSITY
           Office of The University Registrar
                                   VERIFICATION REQUEST FORM

                                                                               TERM:                            20
                       ,
LAST NAME                  FIRST               MI                                   FAMU STUDENT ID NUMBER

                                            (CHECK ALL THAT APPLY)
   CURRENT ENROLLMENT STATUS                                                     MAIL LETTER
                                                                                    (Allow 3-5 Working Days of Mail)


   DATES OF ATTENDANCE


   ANTICIPATED DATE OF GRADUATION                                                OTHER:
                                                                                 (Specify)

PURPOSE OF LETTER:

THE CERTIFICATION WILL BE REPORTED IN ACCORDANCE WITH THE ACADEMIC RECORDS AS OF THE DATE PREPARED.
I AUTHORIZE FLORIDA A&M UNIVERSITY TO RELEASE THE INFORMATION INDICATED ABOVE:
THIS CERTIFICATION WILL BE MAILED DIRECTLY TO THE ADDRESS BELOW. PLEASE ALLOW 3-5 WORKING DAYS FOR PROCESSING.

                                                                                    (         )        –
STUDENT SIGNATURE                                          DATE                              TELEPHONE NUMBER
ADDRESS CERTIFICATION IS TO BE MAILED TO:

NAME:                                                              ADDRESS:


CITY & STATE:                                                      ZIP CODE: