Fillable THIRD PARTY AUTHORIZATION STUDENT INFORMATION If someone will (University of South Florida)

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THIRD PARTY AUTHORIZATION STUDENT INFORMATION If someone will (University of South Florida)

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THIRD PARTY
AUTHORIZATION
Forms and additional documentation can be uploaded directly to your application, or submitted to the Ofce of Admissions.
Ofce of Admissions | 4202 E. Fowler Ave., SVC 1036 | Tampa, FL 33620 | P: 813-974-3350 | F: 813-974-9689 | E: admissions@usf.edu
If someone will be making inquiries on your behalf during the application process, this form must be completed and returned to
our ofce before any information will be released to a third party. NOTE: Only one person may be designated to receive
information on your behalf.
STUDENT INFORMATION
Date of Birth: ______________________ University ID: ______________________Term of Entry: ________________________
First Name: _______________________ Middle Name: ______________________Last Name: __________________________
Email Address: _________________________________________________________________________________________
THIRD PARTY INFORMATION
First Name: _______________________________________Last Name: ___________________________________________
Relationship to Student: __________________________________________________________________________________
Email Address: _________________________________________________________________________________________
SIGNATURE
“I do hereby authorize _______________________________________, the individual named above, to inquire and receive any
information on my behalf regarding my application to the University of South Florida”.
Student Signature: __________________________________________________ Date:_______________________________
Print Name: ___________________________________________________________________________________________
Please Note: You can use the electronic signature in the llable PDF forms and upload the signed document to your online application or
email it to admissions@usf.edu. You do not need to print and sign by hand. However, your signature (whether wet or electronic) still
certies that the information submitted is accurate.
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THIRD PARTY AUTHORIZATION STUDENT INFORMATION If someone will (University of South Florida)

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Completed 20 January 2021

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