Credential Request Form
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Counseling and Career Services
816 Chestnut, 304 Founders Hall
Lincoln University
Jefferson City, MO 65101
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CAREER PLACEMENT CREDENTIALS REQUEST
In order to expedite your request to have your Career Placement Credentials sent to a prospective employer, please complete the following form. Only one request per form. Please enclose a money order or cashier's check in the amount of $5.00 per prospective employer, if this is not your first request.
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| NAME: |
SSN#: |
ADDRESS:
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| CITY: |
STATE: |
ZIP: |
| PHONE: |
| IS THIS YOUR FIRST REQUEST? |
YES
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NO
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CAREER CREDENTIAL FILE SHOULD BE SENT TO THE FOLLOWING PERSON(S):
NAME/TITLE:
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ORGANIZATION:
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ADDRESS:
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CITY / STATE / ZIP CODE:
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TITLE OF POSITION FOR WHICH YOU ARE APPLYING?
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SIGNATURE OF STUDENT / ALUMNI
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DATE
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* * * * * * * * OFFICE USE ONLY * * * * * * * * |
FREE REQUEST
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YES
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NO
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FEE ENCLOSED
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YES
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NO
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