Enrollment Certification Request Form

This request form is for students that are currently attending or have previously attended Georgia Southern University.

This is not a new or future student Admissions Form.

Personal Information

Eagle ID Number (do not include dashes ex:123456789): 

Last Name: 

First Name: 

Middle Name: 

Phone Number: 

E-mail Address: 

PLEASE NOTE:

Directory information which consists of name, address, telephone number, date and place of birth, major, participation in activities, weight and height of members of athletic teams, dates of attendance, degrees and awards received, and the most recent educational institution attended is considered public information and will be released to those requesting such information, unless the student has specifically requested that information in this category be restricted. All other information requires a signature and cannot be accepted via e-mail.
****SELECT ONLY THE INFORMATION YOU NEED TO BE CERTIFIED****

Specify term and year that letter is to be certified:
  

CERTIFICATION/INSURANCE  This letter will certify: Enrollment Status, Billing Hours, Credit Hours, Term Start Date, Class, and Expected Graduation Date.
Insurance Provider:
Insured: Account or Identification Number:
Attention To: Fax Number:


MILITARY ID  This letter will certify: Enrollment Status, Billing Hours, Credit Hours, Class, Term Start Date, Expected Graduation Date, Last Term Attended, Primary Curriculum, and Pending Degree.

ENROLLMENT HISTORY  This letter will certify: Enrollment Status, Billing Hours, Credit Hours, Class, Enrollment History, Term Start Date, Expected Graduation Date, Pending Degree, Awarded Degree, and Primary Curriculum.

Address 1
Mail to:  
Street:  
City:  State:  Zip: 
Attention To: 
Fax Number: 
 
Address 2
Mail to:  
Street:  
City:  State:  Zip: 
Attention To: 
Fax Number: 


  

OR

Return Form to:

Office of the Registrar
PO Box 8092
Georgia Southern University
Statesboro, Georgia 30460-8092
Phone: 912-478-5152  Fax:  912-478-0081