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"For
your convenience print, complete & return this form"
KENT STATE UNIVERSITY
OFFICE OF THE UNIVERSITY REGISTRAR
INFORMATION RELEASE FORM
I hereby authorize the Office of the
University Registrar to release information regarding my student status.
| _______________________________________ |
___________________________________
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| NAME (PLEASE PRINT) |
FORMER NAME(S)
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__________-___________-______________________ |
(_________)__________-_____________
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| STUDENT ID NUMBER |
DAYTIME PHONE NUMBER
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____________________________________________ |
________________________
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| STUDENT SIGNATURE |
DATE
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I. PLEASE CHECK THE APPROPRIATE LETTER NEEDED:
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__ ENROLLMENT VERIFICATION (Used for
verifying term enrollment)
__VERIFY ALL TERMS OF ENROLLMENT
__VERIFY THE FOLLOWING TERM AND YEAR |
FALL___________
SPRING_________
SUMMER________
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| __INCLUDE EXPECTED GRADUATION DATE (Date
is term currently listed on SIS) |
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| __ GOOD STUDENT DISCOUNT
LETTER (Used for car insurance, etc.
- must have a 3.00 gpa for last term enrolled) |
| __ GOOD STANDING LETTER
(Used to verify a cumulative 2.00 gpa
grade point average or above for scholarships,
transient approval for coursework at other institutions and for
students transferring to other institutions) |
II. CHECK DESIRED METHOD OF DELIVERY:
___ PICK UP LETTER (AVAILABLE
AFTER 2PM NEXT BUSINESS DAY)
___ MAIL INFORMATION TO:(PROVIDE
COMPLETE MAILING ADDRESS)
___________________________________________________
___________________________________________________
___________________________________________________
___FAX TO: ______________________________________________________________________
FAX NUMBER (_______)________-___________
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