| Mail to: UNC at Pembroke
Office of the Registrar
P.O. Box 1510
Pembroke, NC 28372
|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)
|Birth Date||Degree Pursuing|
|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.
This publication is available in alternative formats upon request.
Please contact Disability Support Services, DF Lowry Building, 521-6695.