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TEMPLE UNIVERSITY

ENROLLMENT VERIFICATION FORM

____________________________,_____________________ __      ________-_____-_________
Last Name                    First Name            MI      Social Security Number                                


Division:                    Check all that apply:
  ___Graduate 		        ____Form attached
  ___Undergraduate              ____Use standard University letter		  
  ___Non-matriculated 
                                     
Indicate all the information to be verified:
___Current semester, or                        ___Anticipated Graduation Date
___Semesters___________ through ___________    ___Degree(s) conferred

___Other__________________________________

NOTE: Also include the insured's or employee's name, social
security and/or insurance group number if different from requestor's for
in-school verification for dependent's benefits. 

Name_______________________________ SSN and/or Group#______________________


Method of Distribution:
____Mail to: (Only one address per form, PLEASE PRINT)   
____Self-service available online at owlnet.temple.edu under Additional Services.

Recipient______________________________________________

Institution____________________________________________

Street_________________________________________________

City, State, Zip_______________________________________


YOUR SIGNATURE (required)_____________________________________ Date:_______

Print your address                 __________________________________			
				
                                   __________________________________
				
                                   __________________________________
				
                                   __________________________________

Daytime phone number	           __________________________________

E-mail address		           __________________________________



Mail Request
To:

Temple University 

Office of Academic Records

1801 N. Broad St.

Philadelphia, PA 19122



FAX-   	 (215)204-6626

Phone- (215)204-1131