CREDENTIALS FILE RELEASE FORM

University of Cincinnati

Career Development Center

620 Old Chemistry Building

P.O. Box 210115

Cincinnati, OH 45221-0115

Date ____________________

Dear Credentials Coordinator,

OPTION I

I hereby request that my entire credential file be sent to me at:

_______________________________________________________________________________________________________

(Name – please print)

_______________________________________________________________________________________________________

(Address)

_______________________________________________________________________________________________________

_______________________________________________________________________________________________________

(City, State & Zip)

_______________________________________________________________________________________________________

(File Holder Name under which file was opened – please print)

_______________________________________________________________________________________________________

File Holder Signature (Must have in order to send out documents.)

_______________________________________________________________________________________________________

Telephone No. (Area Code first)

OPTION II

I hereby request that my entire credential file be sent to:

____________________________________________ _____________________________________________________

(Name) (Title)

_______________________________________________________________________________________________________

(Address)

_______________________________________________________________________________________________________

_______________________________________________________________________________________________________

(City, State & Zip)

_______________________________________________________________________________________________________

File Holder Name (Under which file was opened – please print)

_______________________________________________________________________________________________________

File Holder Signature (Must have in order to send out documents.)

_______________________________________________________________________________________________________

*Authorizing Signature to confirm that file may be sent to above individual and location.

_______________________________________________________________________________________________________

Telephone No. (Area Code first)

OPTION III

I hereby request that my entire credentials file be sent to Reference Now, an on-line credentials service. (Not an endorsement)

_______________________________________________________________________________________________________

File Holder Name (Under which file was opened – please print)

_______________________________________________________________________________________________________

File Holder Signature (Must have in order to send out documents.)

*You are responsible for obtaining the proper signatures authorizing CDC to forward your credentials file to the location you have requested. Files will not be sent to U.C. departments without authorizing signatures on this form.

For Office Use Only

Date sent: _______________________

Processed by: ____________________