Education Verification Form

Education Verification Form
This form should be filled by both the applicant and the University/College registrar together.
Name
First NameLast Name
Date of Birth
MonthDayYear
2 digit month, 2 digit day, 4 digit year1
Please provide information about your highest education level.
School Name
Registrar Office Address
Street Address
Street Address Line 2
CityState / Province
Postal / Zip Code
Credits Earned
Degree to be Obtained
I, the applicant, agree with the following statement:
Date
MonthDayYear
2 digit month, 2 digit day, 4 digit yearDate
Signature
Clear
The applicant do not write below this line.
To be completed by the University or College
Please select the applicable one
Name
First NameLast NameTitle
Date
MonthDayYear
2 digit month, 2 digit day, 4 digit yearDate
Signature
Clear
Should be Empty: