College Verification Form – Student Information

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Directions:

Thank you for reaching out to the Licensure Coordinator. The purpose of this form is to collect your identifying information so the licensure coordinator can complete a College Verification Form (CVF) for your licensure application.

First Name:

Middle Name

Last Name:

Suffix

Email Address

Phone Number

Current Mailing Address

Address Line 1

Address Line 2

City

State

Zip Code

Birthday

Social Security Number

What teaching program did you complete at GMU?

Are you applying for licensure through GMU?

Yes

Additional Comments:

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