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Limited Power of Attorney for Study Abroad

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Limited Power of Attorney for Study Abroad Page 2
Limited Power of Attorney for Study Abroad
LIMITED POWER OF ATTORNEY
(student's full legal name)
I,
SSN:
permanently residing at:
(street address)
(city)
(state)
(zip)
certify that I am studying outside the United States and do hereby make, constitute
(designee's full legal name)
and appoint:
residing at:
(street address)
(city) (state)
(zip)
(permanent tel. #)
(home tel. #)
(daytime tel. #)
in my name, place and stead, and for my use and benefit to act as my legal representative during my participation in study
abroad. The hereby designated Power of Attorney is authorized to (circle yes or no as applicable for all items):
my true and lawful attorney for me and
NoYes
receive checks made payable to me for educational expenses
sign and deposit checks made payable to me
access information in my student account and/or financial assistance files
handle issues related to my financial assistance
process insurance transactions on my behalf
process banking transactions on my behalf
pay bills on my behalf
Other:
This Power of Attorney terminates on:
(mm/dd/yy)
IN WITNESS THEREOF, I have hereunto set my hand and seal on
(mm/dd/yy)
Student Signature:__________________________________________________________________ Date _______________
SIGN ONLY IN THE PRESENCE OF A NOTARY PUBLIC
Signature of Public Notary Officer:___________________________________________________ Date _______________
This instrument was acknowledged before me on
(mm/dd/yy)
NoYes
NoYes
NoYes
NoYes
NoYes
NoYes
NoYes
Printed Name of Public Notary Officer:_______________________________________________ Date _______________
Print Form
Limited Power of Attorney for Study Abroad
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