Enrollment Verification Request Form

This form is intended for student requests for current enrollment verification. Verification cannot be done for future terms. Requests will be processed following the add/drop period of the current term.

Third parties such as student loan providers, employers, credit card companies, travel companies, and consumer product companies should request enrollment verification directly through the National Student Clearinghouse.

Please note that enrollment verifications will only be released directly to the student. For additional information please review the Enrollment Verification webpage or contact the graduate registrar’s office at gradreg@lclark.edu.

Today's Date

Student Information

First Name

Last Name

LC Student ID Number

Date of Birth

LC Email Address

Phone Number

Student Address

Street Address 1

Street Address 2

City

State

Zip Code

Term/Year

Delivery Method

Pick Up (photo ID required)Postal Mail (to above address)

The fields below are optional. You may provide third-party information if you need it printed on the form. Please note: we will only release enrollment verification directly to the student.

Institution Information

Name

Street Address 1

Street Address 2

City

State

Zip Code