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Education Verification Request

*Personal Information*

Subject's Name:
Subject's Name while in school:
Social Security No:
Date of Birth:

Educational Information Provided

Institution and Location:
Dates of Attendance:
Date of Graduation:
Degree or Diploma Awarded:
Major Field of Study:
Comments:

Educational Information Reported

Institution and Location:	________________________________________
Dates of Attendance:	________________________
Date of Graduation:	______________
Degree or Diploma Awarded:	_________________________________________
Major Field of Study:	________________________
Comments:	__________________________________________________
Education Verification	$ 10.00
TAX (TX residents add 8.25%)
TOTAL

Payment Method:
Card type:	Visa MasterCard AmEx Discover Diners Club
Name on Card:
Account Number:
Expiration Date:
EMail Address:

You may click the Submit button, fax the form to 281.419.2502 or mail it to us at the address below. Please enclose a check or money order for the full amount if not paying by credit card.

Selection Management
P.O. Box 130369
The Woodlands, TX 77393-0369 USA
Voice: 281.419.2500, FAX: 281.419.2502