RO-Certification Form

U-M ID Number (if known)

First Name

Middle Name

Last Name

Former Name (If Applicable)

Address (Street, City, State, Zip Code)

Phone Number

Please note below only the information that you need to have verified. The University of Michigan can only certify terms for which you have registered.

Enrollment (month/year to month/year)

Anticipated Date of Graduation (month/year)

Anticipated Degree(s) and Major/Field

Pre-registration (indicate if certification is needed once you have registered but class not begun)

Awarded Degree(s) and Major/Field

Graduation Date(s) (month/year)

Other

I authorize the University of Michigan to verify and release this information to the contacts below:

How would you like to release your information?

Name & Email

If you would like to release your information to multiple emails, please list each one in this text area clearly separated in order to know where to properly release the information.

Name & Address (Street, City, State, Zip Code)

If you would like to release your information to multiple addresses, please list each one in this text area clearly separated in order to know where to properly release the information.

Name & Fax

If you would like to release your information to multiple faxes, please list each one in this text area clearly separated in order to know where to properly release the information.

Signature

Entering your name in the field acts as your electronic signature or approval for this request.

Your name

Your email address

Verification Code

RO-Certification Form

Please note below only the information that you need to have verified. The University of Michigan can only certify terms for which you have registered.

I authorize the University of Michigan to verify and release this information to the contacts below:

Signature

Other Fields