To have your credentials sent by Career Services to prospective employers,
please print, complete,
and return this form with payment to the address listed at the bottom. You may
send an
e-mail request to april.evans@Washburn.edu. Please include all of the information requested
on this form when you make your request via e-mail. Please allow two business days for processing.
Fees are as follows: $4.00 per request mailed and $7.00 per request if faxed. If paying by check,
make payable to "Washburn University." You can call Judy with a credit card number and e-mail the
information needed to mail the credential, if you prefer.
If you need your information sent to more than one prospective employer, please reproduce this
form and complete one form for each request.
If you would like to update your credentials before requesting them contact Career Services.
Questions about your request? Contact april.evans@Washburn.edu Phone: (785) 670-1450
Candidate Information:
Name_______________________________ Date_____________________________________
SS#_________________________________ Grad. Date________________________________
Address_______________________________________________________________________
City/State/Zip__________________________________________________________________
Phone #_____________________________ E-mail____________________________________
Signature______________________________________________________________________
Send Credentials To:
Name/Title____________________________________________________________________
USD #/Organization_____________________________________________________________
Address_______________________________________________________________________
City/State/Zip______________________________ Fax # (if applicable)_____________________
Submit this form with payment to: Career Services - Washburn UniversityFor office use only:
1700 SW College - Morgan 122
Topeka, KS 66621
Date sent________________ Amount Paid $_______________ Cash _______ Check_______
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