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  • Authorisation Form: To Be Picked Up: - )

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    Amir Mohammed
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    This form authorizes a nominee to collect items on behalf of a student from Student Central. The student provides their name and contact details as well as the nominee's name, date of birth, student number if applicable, and contact details. The student specifies what items the nominee can collect, such as academic documents, transcripts, or loan documents. The authorization is valid indefinitely or for a specified time period. Both the student and nominee must sign to acknowledge the authorization terms.

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    Original Title

    Authorization

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    This form authorizes a nominee to collect items on behalf of a student from Student Central. The student provides their name and contact details as well as the nominee's name, date of birth, student number if applicable, and contact details. The student specifies what items the nominee can collect, such as academic documents, transcripts, or loan documents. The authorization is valid indefinitely or for a specified time period. Both the student and nominee must sign to acknowledge the authorization terms.

    Copyright:

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    Download as PDF, TXT or read online from Scribd
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    13 views1 page

    Authorisation Form: To Be Picked Up: - )

    Uploaded by

    Amir Mohammed
    This form authorizes a nominee to collect items on behalf of a student from Student Central. The student provides their name and contact details as well as the nominee's name, date of birth, student number if applicable, and contact details. The student specifies what items the nominee can collect, such as academic documents, transcripts, or loan documents. The authorization is valid indefinitely or for a specified time period. Both the student and nominee must sign to acknowledge the authorization terms.

    Copyright:

    Attribution Non-Commercial (BY-NC)
    Download as PDF, TXT or read online from Scribd
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    of 1

    AuthorisationForm

    ThepurposeofthisformistonominateanotherpersontocollectitemsfromStudentCentralonmybehalf.Iunderstandthat
    Imayonlyauthoriseonepersononthisform.ImaychangethesearrangementsatanytimebycontactingStudentCentral.
    TheinformationIprovideonthisformwillauthorisemynomineetocollectitemsonmybehalfduringtheperiodIspecify.I
    understandthatIshouldonlyallowsomeoneItrusttocollectitemsonmybehalfastheUniversityisnotresponsibleforthe
    securityoruseofmyitemsoncetheyhavebeencollected.
    1.Myname
    FamilyName:____________________________________
    GivenName/s:___________________________________

    2.MydateofBirth

    AcademicConsiderationDocuments
    StudentLoanDocuments
    Other(pleasespecify)
    __________________________________________

    ___/___/___

    11.Iwantthisarrangementtolast:

    3.Mypermanentaddress

    _______________________________________________
    _______________________________________________
    4.Mystudentnumber
    _______________________________________________
    5.Mynomineesname

    IndefinitelyOR
    From___/___/___to___/___/___

    12.Myauthorisation
    Iauthorisethepersonnamedonthisformtocollecttheitems
    listedabovefromStudentCentral.

    8.Mynomineescontactdetails

    Bysigningthisauthorisation,Iacknowledgethat:
    theinformationIhaveprovidediscorrect;
    mynomineemustprovidephotoIDtoStudentCentral
    atthetimeofcollectiontoenableverificationoftheir
    identity(forexample:studentcard*,passport,drivers
    licence);
    StudentCentralwillnotreleaseitemsunlessitis
    satisfiedthatthepersonisauthorised;and
    theUniversityofWollongongacceptsnoresponsibility
    forcollecteditemsoncetheyhavebeencollectedby
    mynominee.

    Address:________________________________________

    Mysignature

    _______________________________________________

    __________________________________________________

    PhoneNumber:__________________________________

    Date

    Email:__________________________________________

    ___/___/___

    9.Numberofitemstobecollected

    13.Mynomineesacceptance

    __________________________________________

    Transcript(pleaseindicatethenumberoftranscript(s)
    tobepickedup:____)

    Bysigningthisauthorisation,mynomineeacknowledgesthat
    he/sheunderstandsandaccepts:
    theresponsibilitieshe/shehasunderthisarrangement;
    thathe/shewillaccess,useanddisclosepersonal
    informationhe/shereceivesonlyasauthorisedbythe
    persontowhomtheinformationrelates;and
    thathis/herappointmentasnomineemayberevokedif
    he/shedoesnotcomplywithhis/herresponsibilities.

    LongCompletionLetter

    Mynomineessignature

    ShortCompletionLetter

    __________________________________________________

    EnrolmentPrint

    Date

    FamilyName:___________________________________
    GivenNames:___________________________________
    6.Mynomineesdateofbirth
    ___/___/___
    7.Mynomineesstudentnumber(ifapplicable)
    ___________________________________________

    10.Itemstobecollected(pleaseticktheappropriate
    boxes)

    GraduationCertificates(Testamur&Transcript)

    EnrolmentStatusLetter
    PaymentAdviceorFeeStatement
    StudentIDCard

    ARD-CS-TEM-035

    ___/___/___
    *StudentcardmustbeacurrentUniversityofWollongongstudentcardorif
    anotherstudentcardisused,itmusthavephotoidentificationandsufficient
    informationtoverifytheidentityoftheperson.
    Authorisation 2009

    Page 1

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