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We will mail/fax the requested data as soon as possible. Are you currently enrolled at Âé¶¹¹û¶³´«Ã½? ( Yes ( No Information requested for (specify year): Spring__________ Summer__________ Fall__________ SPECIFIC INFORMATION REQUIRED: ( Completion of Attached Form ( Good Student Discount Form (usually cannot be processed between semesters) ( In-School Deferment: Expected graduation date? ( Other (specify) ( Letter (specify requested information below) ( Insurance Policyholder’s Name:__________________________Policy Number: ( Semester Grade Point Average ( Official Cumulative Grade Point Average ( Internal Adjusted and Official Cumulative Grade Point Averages ( Enrollment Status (part-time/full-time) ( Hours Enrolled ( Expected Graduation Date ( Class Schedule Additional Information to Include: PURPOSE OF REQUEST: ( Please Mail Information To:  ( Please Fax Information To: ATTN: Co/Dept: Fax No.  FOR OFFICE USE ONLYAccepted By: _____________________________ Date Information Issued:________________________ Processed By:_____________________________ Revised June 2002 @ijkÈíI P ¬ Å È Ü 8 g h s € ‡ Ž � 9 : a c d e j k l îßÒîÒ½Ò«Ò«Ò«Ò«Ò«™«Ò™«Ò‰ÒyÒh[Òh[h”G®h”G®CJOJQJ! jððh”G®h”G®5�CJOJQJh”G®h˜9î5�CJOJQJ\�h”G®h˜9î5�OJQJ\�aJ"h”G®hA!�5�CJOJQJ\�aJ"h”G®h˜9î5�CJOJQJ\�aJ(jh”G®h˜9îOJQJUmHnHuh”G®h˜9îCJOJQJh”G®h˜9îCJOJQJaJ"h”G®h˜9î5�CJOJQJ\�aJ?@jlmÈîI Q ¬ Ý 8 � 9 : p q Ï ùðëðæääßÒÂÒÂÒÒ²²ÒÒÒÒ$ ÆÈû0ýÐ’pa$ ÆÈû0ýÐ’pdh ÆÈû0ýÐ’pdhdäÿd× Æd× ÆËÍþþl m ‹ ™ œ ¢ ¯ µ ¿ Ä Ð î ð ñ     \ ] ^ Ö × Ø ` a � � ‘ © ª Ù ô ö ÷ AB�ޏ¹ÉóæÖæÖæÖæÖæÅæ´æ§´§æ§´æ§´æ´æ”´æ‡æyæ´æ´æ´æ´æ´æh”G®h˜9î>*CJOJQJh”G®hJsCJOJQJ$jh”G®hJs5�CJOJQJUh”G®h”G®CJOJQJ! jððh”G®hJs5�CJOJQJ!h”G®h˜9î5�>*CJOJQJ\�h”G®h˜9î5�CJOJQJ\�h”G®h˜9îCJOJQJh”G®hA!�CJOJQJ+Ï Ð ð  \ Ö ` � õ ö AnŒ¸ÉòßßÌÌ̼¨¨¨¨¨¨•… ÆÈû0ýÐ’pd, ÆÈû0ýÐ’pd,gd”G® ÆÈû0ýÐ’p„Ðd,`„Ð ÆÈû0ýÐ’pdh ÆÈû0ýÐ’pdhgd”G® ÆÈû0ýÐ’pdhgdJs ÆÈû0ýÐ’pÉÊËäþÿ56�±%&BCEF#%êÙ̾°ÙÌ£‰y̾yhÙyÌO7¾y/jh”G®hJs>*CJOJQJUmHnHu0jh”G®hJsCJOJQJUaJmHnHu!h”G®h˜9î5�>*CJOJQJ\�h”G®h˜9î5�CJOJQJ\�2jh”G®hJs5�CJOJQJU\�mHnHuh”G®5�CJOJQJ\�h”G®hJs>*CJOJQJh”G®h˜9î>*CJOJQJh”G®h˜9îCJOJQJ! jððh”G®hJs5�CJOJQJ)jh”G®5�CJOJQJUmHnHuÉÿž$%C$%B‡Ëïïïßßßßʲ¬Ê²²²š ÆÈû0ýÐ’p$If$If$ ÆÈû0ýÐ’pd,$Ifa$ ÆÈû0ýÐ’pd,$If ÆÈû0ýÐ’pdh ÆÈû0ýÐ’pd,%&ABCH†‡ˆ�ÊËÌÓ-¹ÊËÌÍÎîÞѺѬѺѬѺѬў�Ñ€Ñ|xÑh˜9îhA!�h”G®h˜9îCJOJQJaJhÕtjh˜9îCJOJQJaJh”G®h˜9î<�CJOJQJh”G®h˜9î>*CJOJQJ,jh”G®hJsCJOJQJUmHnHuh”G®h˜9îCJOJQJh”G®h˜9î5�CJOJQJ\�! jððh”G®hJs5�CJOJQJ­›››GEETkd{$$If”ZÖF°€0*°ÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÐÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿ°ÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿöÖ ÿÿÿÿÿÿÿÿÿÿÿÿÖ ÿÿÿÿÿÿÿÿÿÿÿÿÖ ÿÿÿÿÿÿÿÿÿÿÿÿÖ ÿÿÿÿÿÿÿÿÿÿÿÿaö ÆÈû0ýÐ’p$IfRkd$$IfÖF°€0*°ÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÐÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿ°ÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿöÖ ÿÿÿÿÿÿÿÿÿÿÿÿÖ ÿÿÿÿÿÿÿÿÿÿÿÿÖ ÿÿÿÿÿÿÿÿÿÿÿÿÖ ÿÿÿÿÿÿÿÿÿÿÿÿaö-XYZ‹Œ·ëë„{ë{ë dˆÿ$Iffkdú$$If–xÖ0&0*&  ÖÖ™™™æææ™™™æææöÖÿÿÖÿÿÖÿÿÖÿÿ4Ö x`Ö ™™™æææaöxpÖ™™™æææ™™™æææ ÆÈû0ýÐ’p¤:$If·¸ËÌÍΘ’��’ Æ0*fkd©$$If–xÖ0&0*&  ÖÖ™™™æææ™™™æææöÖÿÿÖÿÿÖÿÿÖÿÿ4Ö x`Ö ™™™æææaöxpÖ™™™æææ™™™æææ<0P:p”G®BP°Ð/ °à=!°Ð"°Ð#�Ð$� %°°h° 0 �ÐR 00P:p”G®BP°Ð/ °à=!°Ð"°Ð#� $� %°°h°  P0 �ÐòròvòH6 00PBP°Ð/ °à=!°Ð"°Ð#�h$� %°°h°  �Ð6 00PBP°Ð/ °à=!°Ð"°Ð#�h$� %°°h°  �Ð6 00PBP°Ð/ °à=!°Ð"°Ð#�h$� %°°h°  �Ðy$$If!vh5Ö°5ÖÐ5Ö°#v°#vÐ#v°:V öö5Ö°5ÖÐ5Ö°/Ö ÿÿÿÿÿÿÿÿ4Ö}$$If!vh5Ö°5ÖÐ5Ö°#v°#vÐ#v°:V ”Zöö5Ö°5ÖÐ5Ö°/Ö ÿÿÿÿÿÿÿÿ4Ö­$$If–x!vh5Ö&5Ö #v&#v :V –x ÖÖ™™™æææ™™™æææöö5Ö&5Ö 4Ö4Ö x`Ö ™™™æææaöxpÖ™™™æææ™™™æææ­$$If–x!vh5Ö&5Ö #v&#v :V –x ÖÖ™™™æææ™™™æææöö5Ö&5Ö 4Ö4Ö x`Ö ™™™æææaöxpÖ™™™æææ™™™æææ†œP@ñÿP Normal1$7$8$H$OJQJ_HaJmH sH tH DA@òÿ¡D Default Paragraph FontVi@óÿ³V  Table Normal :V ö4Ö4Ö laö (k@ôÿÁ(No List <&@òÿñ< Footnote ReferenceH™@H Js Balloon TextCJOJQJ^JaJÎ ÿÿÿÿÿÿÿÿÿÿö% Î *ÿÿÿÿ>*ÿÿÿÿ’*ÿÿÿÿÊ*ÿÿÿÿ+ÿÿÿÿ?@jlmÈîIQ¬Ý8�9:pqÏÐð\Ö`�õöAnŒ¸Éÿž$%C$ % B ‡ Ë          - X Y Z ‹ Œ · ¸ Ë Ì Ï ˜0€€˜0€€˜0€€˜0€€˜0€€˜0€€˜0€€˜0€€˜0€€˜0€€˜0€€˜0€€˜0€€˜0€€˜0€€˜0€€˜0€€˜0€€˜0€€˜0€€˜0€€˜0€€˜0€€˜0€€˜0€€˜0€€˜0€€˜0€€y‰00€˜0€€˜0€€˜0€€˜0€€˜0€€˜0€€˜0€€˜0€€y‰00€˜0€€˜0€€˜0€€y‰0€©0€€Щ0€€Ð ©0€€Ð ©0€€Щ0€€Щ0€€Щ0€€Щ0€€Ð ™0€€Ô ©0€€Ð ©0€€Ð ©0€€Ð ™0€€Ô y‰00€˜0€€©0€€Ð ©0€€Ð ™0€€Ô ©0€€Щ0€€Ð ©@0€€Ð©0€€Ð ™0€€Ô ˜0€€˜0€€y‰00 l É%Î Ï É·Î Í ð8ð@ñÿÿÿ€€€÷ðØð ðvð( ð ððn ð s ð*�ƒ¿Ëÿ?¿ #"ñ �¿€ðððHB ð C ðD¿ÿðððHB ð C ðD¿ÿðððHB ð C ðD¿ÿðððHB ð C ðD¿ÿðððHB ð  C ðD¿ÿðððHB ð  C ðD¿ÿðððHB ð  C ðD¿ÿðððHB ð  C ðD¿ÿð ððHB ð C ðD¿ÿðððB ðS ð¿Ëÿ ?ðj�ÉCDEB ‡ Ë Î Ð-rÀM"U)tU æmæt�êU)êt ûµût“µ“t+µ+t å+Õ+t Õ0Õ0t Õ5Õ5tÿÿ QuickMarknÏ nÏ ÿÿV4îMW4î?þÿÿÿýÿÿÿBþÿÿÿþÿÿÿþÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿRoot Entryÿÿÿÿÿÿÿÿ ÀF `Û±ÇD€Data ÿÿÿÿÿÿÿÿÿÿÿÿ1Tableÿÿÿÿ©#WordDocumentÿÿÿÿ:+SummaryInformation(ÿÿÿÿÿÿÿÿÿÿÿÿ0DocumentSummaryInformation8ÿÿÿÿÿÿÿÿ8CompObjÿÿÿÿÿÿÿÿÿÿÿÿqÿÿÿÿÿÿÿÿÿÿÿÿþÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿþÿ ÿÿÿÿ ÀFMicrosoft Office Word Document MSWordDocWord.Document.8ô9²q