University of Texas at Dallas
UTD Student ID Number _____ UTD NetID _____ Contact NumbersHome Phone: (_____)_____ Cell Phone: (_____)_____ Back-up E-mail (non-UTD):_____ ... _____I request that the Dean of Students release my disciplinary record to the Health Professions Advising Center for use in preparing my Health Professions Evaluation. If I receive disciplinary action ... ................
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