Information Release Form




School Name                                       






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


(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.