Education verification
Education Verification Form
Education Verification Instructions:
Complete: Educational Institutions Attended
Release of Education Information Consent Form
Return to Office of Research:
Research Office (151)
Telephone: 412-360-2380
Fax: 412-360-2377
Educational Institutions Attended
Name: _________________________ ______ ___________________________
First MI Last
Date of Birth: ___________________________________________________________
|Post-High School Education |Office of the Registrar |Degree |Month & Year |
|Name used if different from above |Address |Earned |Graduated |
| | | | |
| | | | |
| | | | |
| | | | |
| | | | |
Release of Education Information Consent Form
I hereby authorize the VA Pittsburgh Healthcare System to contact the Institution(s) listed on my application for employment or Curriculum Vitae to verify my attendance and degree status.
Name: ___________________________Signature: _______________________Date: _________________
................
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