OFFICE OF THE REGISTRAR
THE UNIVERSITY OF NORTH CAROLINA AT PEMBROKE
ENROLLMENT VERIFICATION FORM
Directions: Please print, complete and return to the Office of the Registrar.
| Request
Date: |
|
| Name: |
Banner ID: |
| Place an "x" beside the requested information: | ||
The
following Release of Confidential Information requires the
student's written consent: (OPTIONAL) |
||
| 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 (Required) |
Please return completed form to:
Office of the Registrar
PO Box 1510
Pembroke, NC 28372-1510
Fax # 910-521-6328Office Location: Lumbee Hall, Room 133
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