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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
https://secure.studentclearinghouse.org/tsorder/faces/PaymentResponse?_adf.ctrl-state=10obrda8x4_37
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4/20/2016
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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