2017 School Verification Form

The School Verification Form is required and to be filled out by school counselors only.

Counselor Information

Student Information

Student Date of Birth

Student Academics

Covering a period from
This GPA is
Anticipated graduation date




Has the applicant ever been found responsible for a disciplinary violation at your school, whether related to academic misconduct or behavioral misconduct, that resulted in a disciplinary action? These actions could include, but are not limited to: probation, suspension, removal, dismissal, or expulsion from your institution.
To your knowledge, has the applicant ever been adjudicated guilty or convicted of a misdemeanor or felony?
Note that you are not required to answer "yes" to this question, or provide an explanation, if the criminal adjudication or conviction has been expunged, sealed, annulled, pardoned, destroyed, erased, impounded, or otherwise ordered to be kept confidential by a court.

Applicants are expected to immediately notify Miami University should there be any changes to the information requested in this application, including disciplinary history.

I have fully advised this student and his/her parent(s) or legal guardian(s) of all the available options and ramifications involved in the College Credit Plus Program.