In order to provide this service without a charge the following items are required:
1. A legible signed authorization to release information from the individual who is being verified.
The release form must:
• take into account the liability of this institution as a third party that is providing information about the individual to another party
• contain the printed name of the individual on all pages of the release form as many signatures are not recognizable
• be signed (no electronic signatures) and dated within seven years of the date of the verification request.
2. A legible company credential form that has the company name, complete address, name of credentialing agent and his/her personal company telephone with extension as well as his/her personal company email.
This form must:
• have the information on it that you would like to be verified and
• have the name of the student while in attendance at the college, if different, on it. This is the form that will be returned to you.
EMAIL Process – The above items must be emailed to email@example.com from the credentialing agent’s personal company email. The processed form will be returned to the same email.
US MAIL Process – The above two items and a self-addressed envelope must be mailed to the Registrar’s Office (address at the top of this form). This envelope will be used to return your processed form.
Quotas: Approximately ten verifications per week will be processed for each agency without a fee as long as the above policy is followed.
Processing Time: Verifications are normally processed within three to five business days upon receipt.
Fax Requests: Verifications that are faxed will usually not be processed. A faxed document may not be acknowledged or returned. If the verification is completed as a courtesy, a fee of $15.00 may be assessed.
Priority Mail: Agencies may send items priority mail and submit a return postage paid priority mail envelope if time is a factor.
Fees: Non-compliance - A processing fee of $15.00 per verification request will be assessed for agencies that repeatedly do not comply with these requirements. This includes having to obtain authorization from the individual. Any further requests will not be processed until the fee is paid.
Quota Overages - Agencies that need more than ten verifications to be processed per week should submit a check to cover the processing fee of $10.00 per additional verification. If no fee is submitted, the requests will be held for processing over the next week(s) until all are completed.
TWO SAMPLES OF AUTHORIZATION AND LIABILITY RELEASES:
A. I hereby authorize [list company name here] to obtain information from any institution or other facility where I am/have been associated, have/had privileges, or am/was employed.
I hereby release from liability any and all individuals and organizations that provide information to [list company name here], in good faith and without malice, concerning my professional competence, ethics, character and education. I hereby consent to the release of all such information.
B. I consent to the release, by any person to [list company name here], of any and all information that may be reasonably relevant to an evaluation of my professional credentials, education, competency, character, ability to practice in the areas in which I have requested privileges, and to my moral and ethical qualifications, including any information relating to any disciplinary action, suspension, limitation, or revocation of privileges.
I hereby release from any and all liability, each and every individual, organization and/or third party that, in good faith and without malice or misconduct, provides information to [list company name here], concerning my professional qualifications and competence.