Information Release Form

School Name

Address

Attn: Transcripts and Records Office

Dear Sir or Madam:

This is to authorize release of information pertaining to my enrollment to:

Embassy of the State of Kuwait

Cultural Division

Attn:

(Academic Adviser)

3500 International Drive, NW

Washington, D.C. 20008

My dates of attendance were from to . My social security/school I.D. number is . My complete name appears in your records as and my date of birth is

.

Thank you for your kind assistance in this matter.

(Signature)