Primary_Source_Verification_Form.DOC
DOC document 26 KB Posted
- Solicitation number
- PC-15-R-002
- Issued by
-
Peace Corps
About this file
Primary Source Verification Form
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Revised 3/21/2012
PRIMARY SOURCE VERIFICATION OF PROFESSIONAL SCHOOL ATTENDED
Date:
College/university
Address
RE:
Name of Degree
Date Awarded
To Whom It May Concern:
I am applying for a contract with the Peace Corps. The application process requires that I ask you to complete and return this form by (commercial express mail or by fax only) directly to:
Paul D. Coverdell Peace Corps Headquarters
Office of Medical services 1111 20th ST. NW
Fifth floor
Washington, DC 20526
Attention: PCMO Program Coordinator Fax: 202.692.1471 I give my consent for this information to be released to the Peace Corps and have signed below.
Sincerely, Signature
Print Name
Address
Telephone
VERIFICATION
The above named individual attended this college/university from ____________ to
Degree Awarded:
Signed:
Print name:
Title:
Revised 3/21/2012
File details come from the government source that posted it. Updated .