Enrollment Verification Form

Student Information

Title

First Name*

Middle Name

Last Name*

University ID (UNI)*

Union Email Address*

Phone Number*

Academic Information

Are you a current student?*

Degree*

Recipient Information

Name/Agency *

Address*

City*

State*

Zip*

Please select your delivery method*

Authorization

The following checkbox serves as a digital signature, authorizing Union Theological Seminary in the City of New York to release the enrollment information from Union to the individuals and/or organizations listed in this form.

I authorize Union Theological Seminary to release my enrollment verification*