REQUEST FOR ENROLLMENT/EDUCATION VERIFICATION

1701 North State Street, Campus Box 150436

Jackson, MS 39210-0001

Web: www.millsaps.edu/records

Email: records@millsaps.edu

Office: Academic Complex, Room 142

Phone: 601-974-1120

Fax: 601-974-1114

REQUEST FOR ENROLLMENT/EDUCATION VERIFICATION

Please print full name on Millsaps College Record _______________________________________________

Today’s Date _______________ SSN____________________ DOB ________________________

Phone _______________ Email ___________________________ Are you currently enrolled? Y or N

If no, provide last semester attended _______________ or graduation date _______________

Address where it should be sent to:

________________________________________________

This enrollment verification is being sent under the provisions of the Family Educational Rights and Privacy Act of 1974. The

following information is automatically included in the verification letter:

 Your name

 SSN

 DOB

 Terms Enrolled

o Start Date and End Date of those terms

o Whether you were an undergraduate or graduate during those terms

o How many credits you attempted during the term and whether you were fulltime

o How many credits you completed during the term

 Degree and Major

 Degree Date/Anticipated Completion Date

 Registrar Signature

If you would like additional information to be included such as your academic standing or GPA, please indicate what else

needs to be included:

___________________________________________________________

Student Signature: ____________________________________________

Form last updated: 9/15/2016

FOR OFFICE USE ONLY

Date received _____________

Date processed _____________

Initial _____