Office of Student Rights and ResponsibilitiesThe Office of Student Rights and Responsibilities can provide a University Conduct Record Verification for students planning to study abroad or applying to graduate school, jobs or other programs. To request a verification please complete this form and submit any additional documents that need to be completed by our office. By submitting this request, you are providing our office authorization to release your student conduct records. Once received we will complete the verification as authorized and it may take up to 5 business days to complete. Full Name Student ID Cell Phone Current Address Permanent Address Date of Birth Month MonthJanFebMarAprMayJunJulAugSepOctNovDec Day Day12345678910111213141516171819202122232425262728293031 Year Year192619271928192919301931193219331934193519361937193819391940194119421943194419451946194719481949195019511952195319541955195619571958195919601961196219631964196519661967196819691970197119721973197419751976197719781979198019811982198319841985198619871988198919901991199219931994199519961997199819992000200120022003200420052006200720082009201020112012201320142015201620172018201920202021202220232024202520262027 UC Merced Email Address Age Class Standing Freshman Sophomore Junior Senior Grad Major Are you a summer session only student? No Yes - what is your home campus? Are you a summer session only student? Yes - what is your home campus? I give authorization for the Office of Student Rights & Responsibilities (OSRR) to release the following information: (Select all that apply) Discuss my student conduct record(s) or alleged violations with the individual(s) or agency, office, department provided. Report on my student conduct history for the purposes of a verification to the individual(s), agency, office, or department provided. A signed copy of the clearance form must be provided to our office by the student or requesting agency, office or department. Other: Please specify I give authorization for the Office of Student Rights & Responsibilities (OSRR) to release the following information: (Select all that apply) Other: Please specify CAPTCHAThis question is for testing whether or not you are a human visitor and to prevent automated spam submissions.
