STUDENT CAMPUS CLEARANCE FORM

UNIVERSITY OF ARKANSAS FOR MEDICAL SCIENCES

Student Name: UAMS ID:

Academic College: Degree (ie: PhD, BSN, etc.):

UAMS ID: Departure Term:

Instructions:

1)All items are required unless otherwise noted by the Office of the University Registrar.

2)As each item is completed, it should be initialed by the university staff member confirming completion.

3)Completed form should be returned to the Office of the University Registrar, along with your student ID badge. Questions may be directed to the Office of the University Registrar, 501-526-5600.

Reason for Clearance (please select one):

_____Graduation _____Withdrawal _____Completion of Non-Degree Program

_____Other (please specify):

Required Clearance Items:

Department Staff Initials (to be initialed by UAMS staff once item has been completed)

Library(Education II Bldg--first floor)

______Educational Resources (EDII, Room 8/141)

______Student Financial Services (Bursar/Financial Aid)(Admin West, First Floor)

Parking Services/UAMS Police(Distribution Center, 800 Cottage Drive)

Student Activities and Housing(Residence Hall, Markham St—501-686-5850)

Student ID badge (Office of the University Registrar, CHP Building 2, Room 100)

______Key Shop (If you must keep your keys beyond graduation, your academic department must initial here to confirm that they are handling your keys once complete)

______Academic College Dean’s Office (Stipend Students, Grad School Only: Academic Program Business Administrators)

Did you receive educational assistance from VA while at UAMS? ___Yes ___No

Post-Departure Mailing Address:

Street Address / P.O. Box

() City State ZIP Telephone

Certification:

I certify that I have accurately reported the status of the above requirements, that I have returned all University supplies and equipment and have paid or arranged to pay all outstanding charges or fines due.

Student SignatureDate Signed

Return Completed Form and student ID badge to: UAMS Office of the University Registrar, 4301 W. Markham, Slot #767, Little Rock, AR 72205. Forms may be returned in person to CHP Building 2, Room 100.

General Information and Instructions

Student Financial Services (You will be notified by UAMS email with clearance instructions; this section does not need to be initialed by the SFS office upon completion.)

Academic College Deans’ Offices. Please see the appropriate college office below to clear. If you are a student receiving a stipend for UAMS employment, be sure to contact your academic program business officer to complete any clearance requirements for your employment.

  • Graduate School:
  • College of Health Professions:

Academic Program Business Administrators

  • Graduate School:
  • College of Nursing: Not Applicable