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Uconn Verification Enrollment  Form

Uconn Verification Enrollment Form

Use a health verification enrollment template to make your document workflow more streamlined.

Birth: _____/_____/______ Dates of Attendance: School (Medical or Dental): ______________________________________ From: ________________________ To: __________________________ Please provide preferred contact information where you may be reached: Phone: ______________________________ Email: __________________________________________________ I hereby authorize the University of Connecticut to release verification of enrollment and related documents to the recipient named on this form. Date:...
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