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Pathways Program School Verification Form

The School Verification Form is required for student employment programs and must be signed by an authorized school official. It includes sections for the student to confirm their enrollment status and course load, and for the school official to certify the student's eligibility. The completed form must be faxed to the specified number for processing.

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14 views1 page

Pathways Program School Verification Form

The School Verification Form is required for student employment programs and must be signed by an authorized school official. It includes sections for the student to confirm their enrollment status and course load, and for the school official to certify the student's eligibility. The completed form must be faxed to the specified number for processing.

Uploaded by

us.high.school01
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
Available Formats
Download as PDF, TXT or read online on Scribd
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SCHOOL VERIFICATION FORM

INSTRUCTIONS: This form is required to participate in the student employment programs and must be
signed by an authorized school official. Fax completed form to 404-471-2998.

PART I Completed by the student. Vacancy ID #


PART II Completed by the school official.
PART III Completed by the CDC human resources office.

PART I: COMPLETED BY STUDENT

I understand that as a condition for student employment with CDC/ATSDR, I have been accepted for
enrollment, or am enrolled, as a degree (diploma, certificate, etc.) seeking student in an accredited
high school, technical or vocational school, 2-year or 4-year college or university, graduate or
professional school. I am taking or will take at least a half-time academic/vocational/ or technical
course load. The definition of half-time is the definition provided by the school in which I am enrolled. In
addition, I understand that it is my responsibility to immediately notify my supervisor at CDC/ATSDR if at any
time I am no longer enrolled in school.

Note: Students graduating during the current academic year must provide documentation of enrollment in
the upcoming summer or fall session.

Print Student’s Name Student’s ID Number

Student’s Signature Date Signed

PART II: COMPLETED BY AUTHORIZED SCHOOL OFFICIAL. FAX TO 404-471-2998.

I certify that the student named above is enrolled or has been accepted for enrollment at this school as a
degree seeking student taking at least a half-time course load and has an acceptable academic standing.

Name of School Anticipated Date of Graduation

Mailing Address

Authorized Signature Title

Telephone Number E-Mail Address Date Signed

DO NOT WRITE BELOW THIS LINE

PART III: CDC/ATSDR VERIFICATION

By: Date:

HRO Form 0.152


Revised 1/28/2019. Previous versions are obsolete

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