AUTHORIZATION FOR RELEASE OF EXCESS HOURS INFORMATION
PLEASE PRINT:
NAME: ___________________________________________________________________________
First MI Last
COLLEAGUE ID NO.: __________________ SOCIAL SECURITY NO: _____________________
DATE OF BIRTH (MM/DD/YY): __________ PREFERRED PHONE NO: _____________________
TWU EMAIL ADDRESS: ______________________________________________________
I, _________________________________________________________________________________
(Student Full Name)
authorize TEXAS WOMAN’S UNIVERSITY______________________________
( Institution Name)
to obtain all external information about my excess hours from the Texas Higher Education
Coordinating Board as related to the THECB rules section 13.108. I hereby knowingly, freely, and
voluntarily waive any right or cause of action arising as a result of the transmission of my hours from
which any liability may or could accrue to the Texas Higher Education Coordinating Board, the State
of Texas, any other governmental body, institution of higher education, or corporate entity which was
associated with the transmission of the requested information.
I understand that, upon request, TEXAS WOMAN’S UNIVERSITY__________________
(Institution Name )
will provide me with a copy of my information received from the Texas Higher Education
Coordinating Board.
Signed this _______ day of ______________, 20_______
_______________________________________________
(Student Signature)
in the presence of:
_______________________________________________
(Witness Signature)
RETURN COMPLETED FORM TO:
TEXAS WOMAN'S UNIVERSITY
OFFICE OF UNDERGRADUATE STUDIES & ACADEMIC PARTNERSHIPS
PO BOX 425468
DENTON TX 76204-5468
FAX: 940-898-3001
