Scrantonequity.org
Enrollment Verification
By submitting this completed form, this verifies that the student named below is enrolled as a full-time student at your college/university.
Student Name:_______________________________________________________________ Student ID:___________________________________Date:__________/________/_______
Student signature:____________________________________________________________
___________________
The following is to be completed by the college/university for the student listed above.
College/University______________________________________________________________ Date of enrollment:_____________________________________________________________ Full time___________ Part time_________ Admission's Phone____________________ (Attach a copy of Student's schedule) This information submitted is correct to the best of my knowledge.
_____________________________________
Official Signature & Title
___________________
Date
Scranton Equity Exchange PO Box 127
Scranton, ND 58653 701-275-8221
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