EMPLOYMENT CERTIFICATION STATEMENT - d214.org

Business EdVantage

847.925.6847

EMPLOYMENT CERTIFICATION STATEMENT This form is to be completed by the authorized representative and submitted by student before the fee due date. Please PRINT or TYPE all information requested.

Student Name:

___________________________________________________________

Student ID Number: ___________________________________________________________ This statement confirms that the above named individual is employed full time at the company location indicated below and is authorized to participate in the Harper College Business EdVantage Program for the semester. Spring ______

Summer ______

Fall ______

of ______ (year)

______________________________________________________________________________ Full Name of Company or Organization/ Division

______________________________________________________________________________ Company or Organization Address

______________________________________________________________________________ Name of Authorized Representative (Print)

Phone

E-mail

______________________________________________________________________________ Signature of Authorized Representative

Title

Date

Students participating in the Business EdVantage Program must have been employed at a member company/organization since the start of the semester. In addition, they must be residents of Illinois or an adjacent state. The Employment Certification Statement is valid for one semester only. You must submit a completed form for each term of enrollment. This form is reserved for use by employees who reside outside the Harper College district. To qualify for in-district tuition, students must submit a completed form to Harper College at the time of payment. If registering in person, present this form to the registration clerk at the time of registration. If registering by Web/Fax: To assure adequate time for a billing adjustment and for payment to be applied by the due date, immediately after registering fax this form to: Fax: (847) 925-6044 Phone: (847) 925-6707

Attn: Admissions Outreach 1200 W. Algonquin Rd. Palatine, IL 60067 Harper College Office Use Only

Verification Source: ______picture ID ______company letterhead with signature

Verified By:

______ payroll stub ______ called and verified

Date of Verification