Limited Power Of Attorney For Study Abroad Page 2
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1
2LIMITED POWER OF ATTORNEY
I,
SSN:
permanently residing at:
(street address)
(city)
(state)
(zip)
certify that I am studying outside the United States and do hereby make, constitute
(permanent tel. #)
and appoint:
(designee's full legal name)
residing at:
(street address)
(city)
(state)
(zip)
my true and lawful attorney for me and
(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):
Yes
No
receive checks made payable to me for educational expenses
Yes
No
sign and deposit checks made payable to me
Yes
No
handle issues related to my financial assistance
Yes
No
access information in my student account and/or financial assistance files
Yes
No
process banking transactions on my behalf
Yes
No
process insurance transactions on my behalf
Yes
No
pay bills on my behalf
Yes
No
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)
SIGN ONLY IN THE PRESENCE OF A NOTARY PUBLIC
Student Signature:__________________________________________________ Date _______________
Signature of Public Notary Officer:_____________________________________ Date ______________
Printed Name of Public Notary Officer:__________________________________ Date ______________
This instrument was acknowledged before me on
(mm/dd/yy)
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