UES Student Verification
Upi Elementary School *Home of the Totots*
Date of Request
*
/
Month
/
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
1
2
3
4
5
6
7
8
9
10
11
12
:
Hour
00
01
02
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11
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44
45
46
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49
50
51
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53
54
55
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57
58
59
Minutes
AM
PM
AM/PM Option
This verification request is for:
*
DPHSS (Public Assistance)
Guam Revenue & Tax
GHURA/Section 8
IT&E
GTA
Docomo Pacific
Social Security Administration
Other
Please indicate "other"
Student's Home Address
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Do you receive mail at your home address?
*
Yes
No
Student's Mailing Address
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
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Next
Student Information
How many child(ren)?
1
2
3
4
5
6
*Any additional students, you will need to submit another request.
Student Name (1)
First Name
Last Name
Date of Birth (1)
-
Month
-
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Grade (1)
0
1
2
3
4
5
Choose "0" for Kindergarten
Student Name (2)
First Name
Last Name
Date of Birth (2)
-
Month
-
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Grade (2)
0
1
2
3
4
5
Choose "0" for Kindergarten
Student Name (3)
First Name
Last Name
Date of Birth (3)
-
Month
-
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Grade (3)
0
1
2
3
4
5
Choose "0" for Kindergarten
Student Name (4)
First Name
Last Name
Date of Birth (4)
-
Month
-
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Grade (4)
0
1
2
3
4
5
Choose "0" for Kindergarten
Student Name (5)
First Name
Last Name
Date of Birth (5)
-
Month
-
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Grade (5)
0
1
2
3
4
5
Choose "0" for Kindergarten
Student Name (6)
First Name
Last Name
Date of Birth (6)
-
Month
-
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Grade (6)
0
1
2
3
4
5
Choose "0" for Kindergarten
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Next
Parent Acknowledgement
Initial each statement for acknowledgement.
To ensure that your child's home address is up-to-date, a proof of residency is required upon receiving a student verification of enrollment.
*
I understand that my child's attendance may affect the release of this Verification of Enrollment.
*
I understand that only the parent/legal guardian is authorized to pick up this Verification of Enrollment.
*
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Next
Requestor's Information
Name (Person requesting for this verification)
*
First Name
Last Name
Best Contact Number
*
-
Area Code
Phone Number
Email
*
example@example.com
Submit
Should be Empty: