The University of
North Carolina at Pembroke Student
Activities Office PO Box 1510 Pembroke NC
28372-1510 (910) 521-6207 This is to certify that I, _________________________
(Full name)
give
permission to the Office of Student Activities at The University of North
Carolina at Pembroke to release academic information to CC chapter of GSE
fraternity for the purpose of ________________________________________ (“confirmation of
eligibility” please fill in statement) Phone Number: __________________________________ E-mail Address: __________________________________ Social Security Number: ___________________________ Hours Attempted: ________________________________ Quality Points: ___________________________________ Overall GPA:_______________________ Chemistry GPA: _____________________ ______________________________________Students Name
(printed) ______________________________________Students
Signature Date:
_________________
Grade Release Form