Verification_Degree._7.9.09.doc

Revised 7/9/2009

VERIFICATION OF DEGREE

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

Room 5206

Washington, DC 20526

Attention: PCMO Program Coordinator Fax: 202.692.1596 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: 7/9/2009