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:
UNCP Degree Awarded   Major Field of Study
Dates of Attendance   Currently Registered at UNCP
     
     
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

 

 

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