ENROLLMENT VERIFICATION FORM

Mail to: UNC at Pembroke
              Office of the Registrar
              P.O. Box 1510
              Pembroke, NC 28372
or Fax:  910-521-6328
  Request Date:
   
Name: Banner ID:
     
Place an "x" beside the requested information:
UNC Pembroke Degree Awarded   Major Field of Study
Dates of Attendance   Currently Registered at UNC Pembroke
     
     
The following Release of Confidential Information requires the student's written consent: (OPTIONAL)
Academic Standing   Comments
Birth Date   Degree Pursuing
Classification   Overall GPA
     
     
     
     
Name and Address of Recipient   Name and Fax Number of Recipient
     
 
     
 
     
 
 
The Family Educational Rights & Privacy Act of 1974, Public Law 93-380, Section 483 requires the written consent of the student before any information, other than directory, can be releases. By my signature on this form, I am requesting that the Office of the Registrar furnish the checked information to the recipient listed.
Student Signature Date

 

This publication is available in alternative formats upon request. 
Please contact Disability Support Services, DF Lowry Building, 521-6695.

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