Employer Verification Form
This will serve to verify that
Signature (Required) ________________________________________________________
Human Resource Director (or equivalent) or Principal or Superintendent (Name Printed)
Human Resource Director (or equivalent) or Principal or Superintendent
Company or School Address:
Surname/Family/Last Given/First Middle Maiden/Other
is a full-time employee of
State: Zip Code:
Name of Participating Company or School District and District Number
Complete this form and return it to the Graduate School via e-mail or through U.S. Postal Service.
This form is required of all first-time recipients and annually thereafter.
Please check one:
BU ID # Program
Employee Development Scholarship
Professional Educators Scholarship
The Graduate School
1501 W. Bradley Ave.
Peoria, IL 61625