Last Name
First Name
UCR ID

MaleFemale UndergraduateGraduate Major      Email      Phone    

(Please Check) I am requesting a: Student Status Letter (Certifying registration for current quarter with expected completion of degree)
Summer School Letter (Permission to attend summer school or another college)
Visit of Relatives for Commencement (List relatives below; letter indicates student status)*
Visit of Relatives (List relatives below; letter indicates student status)*
Number of Copies Requested?  

Address Letter to:
Street City State AK AZ AR CA CO CT DC DE FL GA HI ID IL IN IA KS KY LA ME MD MA MI MN MS MO MT NE NV NH NJ NM NY NC ND OH OK OR PA RI SC SD TN TX UT VT VA WA WV WI WY Zip
I will pick up the letter(s) at the International Education Center
Mail to above address



Other:

I certify that the above information is true and correct.