Education Verification Request | Office of Clinical Placement Coordination

Program coordinators should use this form to request Education Verification for students assigned to an agency that requires it for onboarding. The form will route to OCPC for the appropriate check and then OCPC will send an attestation back to the program.

Requester Name(Required)

First Last

Requester Email(Required)

Student Name(Required)

First Last

Student PeopleSoft #(Required)

Select Student's Program(Required)

Agency Requiring Education Verification(Required)

Phone

This field is for validation purposes and should be left unchanged.