Full Name ____________________________________ SSN# ____________________
Local Address _____________________________________________________________
City _______________________________ State ________________ Zip __________
Phone __________________________________ E-mail __________________________
Permanent Address ________________________________________________________
City ______________________________ State ________________ Zip __________
Major _________________________ Classification ______________________________
Participant Agreement
By signing this form I consent for UNC Charlotte to release all university records relating to my enrollment, attendance, courses, course grades, and other academic assessment to TRACE staff members. Staff members can use this information in assisting with academic advisement, and recommendations and referrals for research, graduate school, internship, co-op and permanent employment opportunities.
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Signature:_______________________________ |
Date:_______________________ |
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TRACE Participant Application .Copyright © 1999 [Academic Initiatives For Mentoring Students]. All rights reserved. Revised: September 28, 2004 |
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