THIRD PARTY EDUCATION VERIFICATION REQUEST FORM
15327 NW 60th Avenue, Room 235, Miami Lakes, FL 33014 Phone: (800) 285-3514 Fax: (954) 538-8041
"Home of the Eagles"
THIRD PARTY EDUCATION VERIFICATION REQUEST FORM
NOTE: Continental Academy will ONLY E-MAIL the information you request. You can expect to receive the information you have requested within 24 to 48 working hours once processed. NOTE: It is your responsibility to ensure that we have received your completed Third Party Education Verification Request Form. Please provide the school a complete and valid e-mail address for the requested information to your company. Thank you for your cooperation.
Date of Request: ______________
Third Party Name: ___________________________________________________
Third Party E-mail Address: ___________________________________________________
Student Name: ______________________________________
Student Date of Birth: __________________________________
Note: We may have a student in our academic records with a different LAST NAME due to marriage etc. Please provide all known names here:
Please provide the information that you are requesting here:
Please provide payment information below. The processing fee is $40.00. E-mail completed form along with the student's signed background authorization release to E-mail: continentalacademyedverify@.
Amount to be charged: $40.00 Credit Card #: _____________________________________________ Valid Thru: ______/______ Security Code: ___________ Name as it appears on Credit Card: _______________________________ Billing Zip Code: ___________ Credit Card Holder Signature: ____________________________________ Date: _____________
OR
Mail in money order or check payment of $40.00 payable to Continental Academy at: 15327 NW 60th Avenue, Room 235, Miami Lakes, FL 33014.
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