Criminal History Admission Clearance CORRECTION OF ERROR Name: DOB: Student ID: Email: Phone: On my application to the University of North Texas I answered “yes” in response to the question “have you ever plead guilty, no contest, or been referred for deferred adjudication, or been convicted of a criminal offense other than a minor traffic violation or do you have criminal charges pending against you at this time?” My response on my application was incorrect. By initialing next to each statement below, I am attesting that the statement is accurate, to the best of my knowledge. I have never plead guilty or no contest to a crime. I have never been referred for deferred adjudication. I am not required to register as a sex offender. I have never been convicted of a criminal offense other than a minor traffic violation. At this time there are no criminal charges pending against me. I understand that providing false or misleading information to the university is grounds for disciplinary action, including possible suspension or expulsion. Signature: Date: Turn in this completed form to the Dean of Students Office. Email: Fax: [email protected] 940.369.8440 Mail: 1155 Union Cir #305008 Denton TX 76203-5017 DEAN OF STUDENTS OFFICE USE ONLY Date received: Application term: Date decided: DOS Representative: Decision: Clear, no conditions Clear with conditions Denied