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Instructions:
PLEASE PRINT or TYPE the information requested. Return to the Office of the Registrar at the address listed above.
Note:
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 ):
1.
2.
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:
02/27/2006
Last Modified Date:
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