Microsoft Word - Good Standing Revised Form 5-10-21

RequestforLetterofGoodStanding

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Thisformisusedtodetermineifanapplicanthasanycurrentacademicordisciplinarysanctionsontheirrecord.Allow5to10business

daysfromreceiptofrequestforprocessing.Beforesubmittingaletterofgoodstanding,OUEmustverifyyouridentity.Arequestsent

throughastudent’sEmory

e‐mailaccountwillnotrequireadditionalverification.Studentswhopresenttherequestinpersonshouldbe

preparedtoshowanEmoryIDorotherofficialformofphotoidentification.Alumniwhosubmitthisformviae‐mailshouldincludea

copyofaphotoidentificationwiththerequest.

Returnto:

OfficeforUndergraduateEducation,300WhiteHall,301DowmanDrive,Atlanta,GA30322;[email protected]

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PleaseNote:RequestsforDeanCertificationtolawschoolmustbeprocessedthroughtheCareerCenter.RequestsforDean

CertificationsformedicalfieldsareprocessedbyPre‐HealthAdvising.ForTransientStudy,thisformisnotrequiredastheLetterofGood

Standingisgeneratedthroughtheapplicationprocess.DONOTUSETHISFORM.

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StudentInformation(PleasePrint)

StudentName: EmoryID:

EmailAddress: MobilePhone:

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PleaseCarefullyReadThisSectionBeforeSigning

IherebyconsenttothereleasebyEmoryCollegeofArts&Sciencesofanyandallrecords,documentation,andinformationregarding

myacademicanddisciplinaryrecordtotheperson(s)orinstitution(s)specifiedbelow.Thisconsentpermitsreleaseofrecords,

documentation,andinformationby

anymeansincludingbutnotlimitedtofurnishingcopiesofdocumentsandsummarizing

informationwhethercontainedindocumentsornot,includingdiscussingfactsandcircumstancessurroundinganyacademicprobation

orexclusionandanyinstanceinwhichIwasallegedorfoundtohaveviolatedtheHonorCode.Ifurtherconsent

thattheOfficefor

UndergraduateEducationmayreviewtheacademicanddisciplinaryrecordsofotheracademicunitsandstudentdisciplinaryofficesat

EmoryUniversityinordertoverifymyacademicanddisciplinaryrecord.TheOfficeforUndergraduateEducationmayreferthisrequest

tootheracademicunitsanddisciplinaryofficestocomplete

theletterofgoodstandingrequest.Iunderstandthattheconsentwill

remainineffectuntiltheOfficeforUndergraduateEducationreceivesmywrittenandsignedrevocationoftheconsent.IreleaseEmory

Universityanditsemployees,includingfaculty,staffandadministrators,anditstrustees,officers,agents,andstudentsfrom

allliability

inreleasingrecords,documentation,andinformationcoveredbythisconsent.

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Signature:

______________________________________________________________________________________________

Date:

________________________________________

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Records,documentation,andinformationmaybereleasedtoperson(s),institution(s)below.

PleaselistthenameofPerson(s)orInstitution(s)towhomyourlettershouldbeaddressed(i.e.DearJaneDoe,OfficeofAdmissionsetc.)

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Pleaseprovidetheinformationbelow

Thisinformationwillbeusedfortheheadingofyourletter.(i.e.addressofschool,institutionetc.Donotenteryourownaddress)

MailingAddress:

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StreetCityState ZipCode

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FaxNumberorEmail: 

SpecialInstructions:

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Revised5/18/2021/MS

DeliveryInstructions(SelectOne):

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EmailtostudentrequestorMailtoaddressaboveFaxHoldforpickup

EmailtoPersonorInstitutionlistedonthisform

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ReasonorPurpose(SelectOne):

BackgroundCheck Military

Employment Internship

GraduateSchool Other(listhere):

Studyatanotherinstitution(non‐Emorycredit)

PLEASENOTE:TheOfficeoftheUniversityRegistrarrequiresacopyofyourofficialtranscript.Oncethecourseworkiscomplete,youmustrequestthehostinstitution

sendanofficialtranscripttothefollowingpostaloremailaddress:

OfficeoftheUniversityRegistrar

Attention:HOPE/CHECS

Coordinator

201DowmanDrive

Suite100

Atlanta,GA30322

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Or:

[email protected]u(forelectronictransmission)

Attention:HOPE/CHECSCoordinator

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