LIMITED POWER OF ATTORNEY
Must be signed in the presence of a legal Notary Public
I, , the undersigned principal by these presents do make, constitute and
appoint my true and lawful attorney-in-fact, for me and in my
name, place and stead and on my behalf, to do and perform for me anything of any character which I might do
or perform for myself if personally present and acting with respect to the following matters only:
1. To endorse federal educational financial aid checks in my name
2. To endorse checks of my home University in my name; name of home University:
3. To endorse negotiable instruments of any character made payable to me and to cash the same or deposit to my account
4. To make deposits to and to draw checks upon any checking account or savings account in any bank wherein I maintain an
account, whether in my name or jointly with another, and in general, to deal with the said bank accounts to the same extent
that I might do if personally present and acting
5. To collect all sums due me from any sources, particularly any sums which are now due or may become due from the
Government of the United Statesor any branch thereof, and to execute such instruments, endorsements or signatures
thereto in my name as may be requisite or proper to facilitate the collection thereof
6 To make contracts on my behalf with respect to my care and upkeep, including the employment of a nurse or nurses,
physicians or any other persons whose services should be needed for my physical or mental care and upkeep
7. To make contracts with respect to my care and treatment at any hospital, nursing home or institution, whose services are
needed, in the opinion of my said attorney-in-fact, for my proper physical or mental care, maintenance and treatment
8. To purchase medicine, clothes, food, or other supplies for my benefit
9. Other:
I also give my attorney-in-fact full power to appoint someone else to act as my attorney-in-fact and full power to revoke
such appointment. This Power of Attorney is executed pursuant to the General Statues of North Carolina, Chapter 32A,
and it is my intention that this Power of Attorney remain in effect, notwithstanding my subsequent incapacity or mental
incompetence; and my attorney-in-fact shall keep full and accurate records of all transactions for me as my agent. It is my
intent that my attorney-in-fact not be required to render inventories or accounts to the Clerk of the Superior Court or any
other public official. This Limited Power of Attorney shall expire on
, 20
.
Address of Principal (Experience Abroad Participant)
Address of Attorney-In-Fact:
Telephone No. of Attorney-In-Fact: ( )
( )
Evening Daytime
IN WITNESS WHEREOF, I have executed the foregoing Power of Attorney this
day of
, 20 .
Signature
State of North Carolina, County of
On this day of , 20 personally appeared before me, the said named
to me and known to me to be the person described in and who executed the foregoing
instrument and he/she acknowledged that he/she executed the same and being duly sworn by me, made oath that the
statements in the foregoing instruments are true.
My Commission Expires:
Notary Public’s Signature
