XUSOM - Xavier University School of Medicine Foundation at Aruba

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Verification of Enrollment

Date

Student Name : *

Last Name : *

First Name : *

Middle Name : *

Student Id : *

SSN/SSI/P# : *

Email : *

Phone Number : *

Student Address : *

Street : *

City / Town : *

State / Zip : *

I hereby authorize Xavier University School of Medicine to release my enrollment information for the following term(s) :

Fall: Spring: Summer: Year(s):

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Attention : *

Special Instructions : : *

I hereby agree to the terms and conditions :

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Please allow 10-15 business days for processing. Students must be academically and financially in good standing. Verification of enrollment may only be for the term of past or present progress, we cannot verify future enrollment.

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