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STUDENT VERIFICATION <br />TO i':1 7, (' if assigned) <br />Hama do Address of Educational Yustitution <br />RF- <br />Applicant/ Ian- Name <br />I hereby authorize release of my student status informadon. <br />Signame of Applicantl"fenant <br />Student ID # <br />ee <br />The individual named directly above is an applicaathettam of a housing proVM that requites verification of student status. The information provided <br />will remain confidential and will be used solely for the pmVose of determining eligibility for occupancY. Your prompt rcapo= i$ crucial and greatly <br />appreciated. <br />Project pwnedManaSemant Agent <br />Retain Form To: <br />The above -named individual lies applied for residency or is currently residing in housing that requires verification of student status. <br />Please provide the information requested below: <br />Is the above -named individual a student at this educational institution? 'YES NO <br />If so, part-time or full -time? PART -TIME FULL -TME <br />If full - tithe, the date the student enrolled as such: <br />Expected date of graduation: <br />I hereby certify that the information supply in this section is true and complete to the best of my knowledge. <br />Date: <br />Signature: <br />Tel. #: <br />Printed Name: <br />Fax #: <br />Title: <br />E -mail: <br />Educational Institution: <br />VOTE: Section 1001 of Title I of the U.S. Code makes it a criminai offense to make willful false statements or ntisreptescntatiorts to any prpartmrn pds � CA► f <br />the Unitod States as to nay matter within its jurisdiction. <br />