Office of Admissions

Graduate Admissions
4400 University Drive, MSN 4C8
Email: masongrad@gmu.edu ; Phone: 703-993-9700

Applicant Approval for Authorized Agent

George Mason University follows FERPA (The Family Education Rights and Privacy Act of 1974) guidelines regarding student privacy.
Please read this contract and sign below that you understand the rules and guidelines for authorizing an agent to check on the status of
your application. You are required to mail or fax the contract back to the Graduate Admissions Office at the address above before we will
communicate with the authorized agent. Please note, we will only speak with one authorized agent per applicant. The Graduate
Admissions office reserves the right to end contact with said authorized agent at any time.

Applicant Name: _______________________________________ GMUID:____________________

Degree/Program: __________________________________________________________________

Phone: ______________________________ Email/Contact: ______________________________

Authorized Agent Name: _______________________________________ GMU ID(if applicable):________________

Relationship to Applicant:  Corporate/Educational Funding Body  Parent  Spouse  Friend  Other ____________

Phone: ______________________________ Email/Contact: ______________________________

Levels of Authorization (Checked below):


 Agent may submit missing items from application with Admissions Representative in order to assure completed applications.
 Agent may discuss missing items from application with Admissions Representative in order to assure completed applications.
 Agent may be informed of applicant final decision. The Graduate Admissions office will not discuss details regarding the reasoning or
justifications from our faculty for admissions decisions with authorized agents.

All of the above

*Please note, if you are an international student, requiring an F1 or J1 Visa, you must contact the Office of International Program and
Services regarding applicant Visa’s. The authorization included in this form does not extend in any way to their office or allow special
permissions to their contact with the applicant.*

To be completed by applicant:

I, ________________________________________, fully understand the provisions set up for creating an authorized agent through the
Office of Graduate Admissions at George Mason University as indicated above. By signing and dating below, I understand that I agree to
the conditions listed above and this authorization will remain in effect until it is revoked by me in writing and delivered to the Office of
Graduate Admissions.

______________________________________________ ___________________________________________
Signature Date
-------------------------------------For Office Use Only-------------------------------------------

□ Date Request received ______________ □ Verified Student ID

Processed by: _____________________ ______ _______________________

Print Signature Date