College Verification Request Form

Office of Clinical Experiences
Darden College of Education and Professional Studies
Suite 1107 Education Building, Norfolk, VA 23529 * 757.683.3348*oce@odu.edu

Note: ODU will verify whether an applicant for licensure has completed a state-approved preparation program at the undergraduate or graduate level. By completing the information below and attaching the state’s college verification form, the appropriate certification/licensure official of the university will complete and return the information to you in 10-14 business days.

Student Full Name Student Full Name * First Middle Last
University/Student ID number or SSN *
Permanent Email *
Phone Phone - ### - ### ####
Verification Information (select all that apply) *

Verification Information (select all that apply) I have been hired by a district and they have requested a college verification form I am working on receiving a provisional license I have completed my approved program and I am working on my state licensure application Other
Please provide your employment information below.
If you are not currently employed, please type 'N/A' for each field.
School Division *
School Name *
State *
City *
Job Title *
Role
Return Directions:
Provide an email address or mailing address that you would like the form returned to, it takes 10-14 business days for the form to be processed.
Return form to this email address *
Provide your address if you need a copy returned by mail (please put N/A if you do not need a copy returned by mail) Provide your address if you need a copy returned by mail (please put N/A if you do not need a copy returned by mail) *
Street Address Address Line 2 City State / Province / Region Postal / Zip Code Country
Attach College Verification form - to process Virginia Department of Education forms make sure you complete PART 1 ONLY (and that your information has saved). All other states fill out all areas that say "to be completed by applicant" prior to submitting. *

Attach Files
Phone Phone - ### - ### ####
Spam Protection. Please answer this simple question.
4, 5, 6, 7 : the 3rd number is?