1. University of Virginia
  2. Arts & Sciences

CREDENTIALS SERVICE APPLICATION

   CREDENTIALS SERVICE APPLICATION

 

Mail to:
Credentials Service
UVa English Department
PO Box 400121
219 Bryan Hall
Charlottesville, VA 22904-4121

or Email to:
Colette Dabney at cdt4u@virginia.edu

 


Registrant Data (Please print clearly or type)

Name:      

Address:

Contact Phone Number:       E-mail:     

Degree Received:  


To be read and signed by all registrants:

By establishing an employment credentials file in the English Department, I agree to abide by the policies that are, or may be, established by the English Department Credentials Service and those that are in accordance with University, State, and Federal authorities. I understand and accept my obligations and the obligations of the English Department Credentials Service with regard to the use of the file and hereby authorize release of my file to employment / admissions officials per my written request.

Signature:___________________________________________

Date: _________________________


Waiver of right of access to confidential recommendations: (to be signed only by registrants establishing a CONFIDENTIAL file)

I hereby waive my right of access to confidential statements of recommendation maintained by the English Department Credentials Service. I understand that said waiver can only be revoked in writing and only with respect to confidential recommendations placed in my file subsequent to written revocation.

Signature:_______________________________________

Date:____________________________