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PLEASE PRINT or TYPE the information requested. Return to the Office of the Registrar at the address listed above.
Certification of upcoming enrollment will not be processed prior to the initial payment for that term.
PRINT School Term(s) needing certification
PRINT Anticipated graduation date
Check the appropriate school:
PRINT Last Name, First Name, Middle Name
Student ID or SSN
Send the above information to ( PRINT ):
Student's Signature
Enrollment Certification Request

The University of Texas Health Science Center at Houston
Office of Registrar
P.O. Box 20036 - UCT 2250, Houston, TX 77225
(713) 500-3361 Fax: (713) 500-3356
Permission to include SSN on certification:
Permission to include Student ID on certification:
Last Modified Date:
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