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4/20/2016

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ElectronicConsentAuthorizationConfirmation
TranscriptOrderNumber:

21157054

ConsenttoReleaseInformationfromEducationRecords
Onlythestudenthim/herselfmaysignthisform
Theundersignedindividualauthorizes
UniversityofKansas
toreleasetheofficialtranscriptofhis/hereducationrecordtotheindividualsand/ororganizationslistedbelowandagreestothechargesonhis/her
creditordebitcardresultingfromthisorder(whichwillappearonhis/hercreditordebitcardstatementasCollegeTranscript).

UNIVERSITYOFMISSOURIKANSASCITY
(UMKC)
Attention:OFFICEOFADMISSIONS
5100ROCKHILLROAD
KANSASCITY,KS64110
StudentName: NANCY GONZALEZ

AuthorizedforOrderNumber: 21157054

04/20/20165:11PMET

StudentSignature
Date

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4/20/2016

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SelfcertificationStatement
Bycheckingthisbox,I,NANCYGONZALEZ,certifythatIamtheabovenamedstudentandmyelectronicsignatureprovidedonthisformis
authenticandhasthesamevalidityandlegallybindingeffectassigningthisconsentformbymyhandinink.

Inordertocompleteyourtranscriptorder,youmustelectronicallysignthisconsentform.Whenwereceiveyourconsentform,NationalStudent
Clearinghousewillsendyouanotification(viaemailortext,dependingonwhatyouselectedasyourpreference)oncetheconsentformhasbeen
processed.

ImportantInformation
Instructionstoelectronicallysignthisconsentform:
1.OnaPC:Holddowntheleftbuttononyourmouseand,usingthemouse,signyournameinthesignatureboxasyouwouldwithapen.
2.OnaniPadoriPhone:Signyournameinthesignatureboxusingyourfingerasastylus.
3.Ifyouarenotsatisfiedwithyoursignature,selecttheClearandResignbuttontoclearyoursignaturesoyoucansignagain.
4.Aftersigningyourname,checktheboxnexttotheselfcertificationstatement.
5.Select"Submit".

Theinformationcontainedinthistransmissionmaycontainprivilegedandconfidentialinformation.Itisintendedonlyfortheuseoftheperson(s)
namedaboveandtheNationalStudentClearinghouse.Ifyouarenottheintendedrecipient,youareherebynotifiedthatanyreview,dissemination,
distribution,orduplicationofthiscommunicationisstrictlyprohibited.Ifyouarenottheintendedrecipient,pleasedestroyallcopiesoftheoriginal
message.

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2016 NationalStudentClearinghouse.Allrightsreserved.
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