Office of the Registrar
(973) 300-2218 • sussex.edu
One College Hill Road • Newton, NJ 07860
CERTIFICATION AND/OR RECORDS REQUEST
Student ID # ________________
Today’s Date _____________________
Student Name ________________________________________________________________________
Phone Number ____________________________________
REQUEST:
Certification of Enrollment ☐
Immunization Records ☐
Other ☐
Which Semesters:
Spring ☐
Winterim ☐
Fall ☐
Summer ☐
Which Year(s): ___________________________________________________
Form attached ☐
Will pick up ☐
Date to be picked up: ________________________________
Please Mail/Fax to: ________________________________________________________________________
_________________________________________________________________________
Email when ready ☐ _________________________________________________________@stu.sussex.edu
(Sussex Email)
Student Signature __________________________________________________________________________
NOTE: Official enrollment certification for a current semester can only be done
AFTER THE 10TH DAY OF CLASSES.
OFFICE USE ONLY
Date completed/sent ___________________________ Unofficial
Staff Initials __________________________________
Date completed/sent ___________________________ Official
Staff Initials __________________________________
Credits and Semester Certifying _______________________________________________________________________________
White: Registrar
Yellow: Student