LONGWOOD UNIVERSITY
ENROLLMENT VERIFICATION
SIGN THE FORM AND RETURN TO THE ADDRESS BELOW:
Registration Office
Longwood University
201 High Street
Farmville, Va 23909
(434) 395-2580
or fax (434) 395 2252
** Please Print **
Student's Name
: _______________________________________________
ID Number: _____________________________
Address: _____________________________________________
______________________________________________
City
State
Zip
Student's Signature: _____________________________________________
Date Requested: ____________________________________
Dates to be verified: ____________________________________
____________________________________
The address(es) where the Enrollment Verification should be sent:
Name: _____________________________________________
Address: _____________________________________________
______________________________________________
City
State
Zip
Name: _____________________________________________
Address: _____________________________________________
______________________________________________
City
State
Zip
Check appropriate box: Mail: _________ Will pick up: _______