Felony Release Form
Your application for admission to Southeast Missouri State University is being reviewed. In order to
proceed further, we need your authorization to contact the Board of Probation and Parole in regard to the
nature of the offense for which you were convicted and your compliance with the terms and conditions of
your parole.
Should you choose to consent to the authorization, please complete, sign the section below and return to:
admissions@semo.edu or Southeast Missouri State University, One University Plaza MS 3550, Cape
Girardeau, MO 63701. The felony review process takes a minimum of two weeks to complete. Therefore,
we must receive this completed authorization two weeks prior to the beginning of the semester for which you
are applying. If this completed authorization is not received by the deadline, it will not be processed.
Semester start dates can be viewed at http://www.semo.edu/facultysenate/calendar.
-------------------------------------------------------------------------------------------------------------------------------------------State in which the offense was committed: _________________________
Parole/Probation Office Address:
_______________________________________________________________________________
Parole/Probation Office Telephone: (________) ____________________
I, ____________________________________________, hereby authorize Southeast Missouri State University
to contact the State Board of Probation and Parole in regard to the nature of the offense for which I was
convicted and my compliance with the terms and conditions of my parole.
Social Security Number: __________________________________
Signature ______________________________________________ Date ___________________
In accordance with the Jeanne Clery Disclosure Act, Southeast Missouri State University makes available to the
campus community and its visitors detailed information on campus crime statistics at
http://semo.edu/police/statistics/.
One University Plaza \ Cape Girardeau, Missouri 63701 \ 573.651.2000 \ semo.edu