Dean Certification Request Form

Background Information

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School of Enrollment:(Required):

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Enrolled in a second school?(Required):

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Today's Date(Required):

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Specific Program/Major:

Your Information

Please provide all of this information; if you do not know/recall your NUID number, you may leave that field blank. Your current phone, address, and email are important in case we need to contact you.

Your Full Name Used at NU

Your NUID Number

Your DOB (YYYY-MM-DD)

Current phone number

Current email address

Additional Information

When did you attend Northwestern? (Please provide the first & last quarters you attended)(Required) This field is required.

Did you graduate, receive a degree and/or complete a program/certificate at NU?

YES NO NOT SURE

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Please list the name of EACH of the institutions to which we should send a report, as well as the contact information (mailing address, e-mail address, fax number, etc.) we should use to send it. Example: Prestigious University. Mailing Address: Prestigious University Registrar; 1234 Prestige Drive; Prestige, IL 00000(Required) This field is required.

Do you have a specific candidate or applicant number that we need to reference on our report?(Required)

YES (please enter the number below) NO

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What is your specific candidate/applicant number? This field is required.

Any other comments or specific requests? This field is required.

Supporting Documentation

Please be sure to complete, sign, and attach the following documents to ensure timely completion of your request:
(1) Any documents/forms from the institutions to which you want us to send a report; and
(2) A Completed Consent Form (pdf) that lists each institution to which you want us to send a report.
5GB maximum total size.
Attachments require time to upload, so please be patient after submitting this form.

Submission