Lane Four - UofM Global

Complete the Lane Four Interest Form below. A UofM Global Advocate will contact you to help create the best track for you.

First Name*

Last Name*

Email Address*

Phone*

Date of Birth (MM/DD/YYYY)*

Employee Number*

Job Title/Division*

Work Location*

Education Level*

Are you currently enrolled in college?*

Have you ever attended the University of Memphis?*

I authorize the release of my Nikie training records and current Tuition Assistance balance.*

To receive tuition assistance through this program we must share your educational records (including financial aid, grades, academic progress, etc) with your employer. The privacy of your educational records is normally protected under the Federal Educational Rights and Privacy Act (FERPA). Please review the FERPA guidelines linked below and respond to the following statement: I approve the release of my educational information to my employer and any third party directly related to my tuition benefits. I understand that this information is normally protected under FERPA guidelines, however I give my consent to share this information for the purpose of this program’s direct billing process. I also understand that if I do not give my consent, I will not be able to participate in this program.

FERPA Guidelines*

Yes

No

To receive tuition assistance through this program we must share your educational records (including financial aid, grades, academic progress, etc) with your employer. The privacy of your educational records is normally protected under the Federal Educational Rights and Privacy Act (FERPA). Please review the FERPA guidelines linked below and respond to the following statement: I approve the release of my educational information to my employer and any third party directly related to my tuition benefits. I understand that this information is normally protected under FERPA guidelines, however I give my consent to share this information for the purpose of this program’s direct billing process. I also understand that if I do not give my consent, I will not be able to participate in this program.

Lane Four Terms and Conditions Agreement*

Yes, I agree to the terms and conditions of the Lane Four program

No, I do not agree with the terms and conditions of the Lane Four program.

Text Messages (Optional)

I agree to receive text message communications from the University of Memphis

UofM Global

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Put Yourself in the Best Position to Succeed: Lane Four

UofM Global

UofM Global

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Put Yourself in the Best Position to Succeed: Lane Four