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THE UNIVERSITY OF TENNESSEE

Student Loans

HEALTH SCIENCE CENTER 62 South Dunlap, Suite 107

Memphis, TN 38163

POWER OF ATTORNEY

STATE OF TENNESSEE

COUNTY OF SHELBY

KNOW ALL BY THOSE PRESENT, that I, ___________________________, of the City of Memphis, County of

Shelby, State of Tennessee, do hereby make, constitute and appoint _______________________ of the city of Memphis, County

of Shelby, State of Tennessee, my true and lawful attorney in fact for me and in my name, place and stead, and on my behalf, and

for my use and benefit to do the following:

Pick up and receive any and all student financial aid checks of any and all kind whatsoever and to do any act

which would be necessary for me to do if I were personally present and acting in connection with any financial aid

checks, with full power of substitution and revocation, hereby ratifying and affirming that which my lawful

attorney in fact shall lawfully do or cause to be done by virtue of the power herein conferred.

I further covenant and agree to hold harmless any person who may act in reliance upon the authority granted

herein to my attorney in fact.

This power of attorney shall remain in full force and effect for a period of ______ days from the date signed

herein and shall expire by its own terms thereafter.

This power of attorney shall not be affected by subsequent disability or incapacity of the principal.

IN WITNESS WHEREOF, I have hereunto set my hand and seal this _______ day of __________________, 20____.

___________________________________________

Student Signature

STATE OF TENNESSEE

COUNTY OF SHELBY

Personally

came

before

me,

this

______ day

_________________,

20____,

the

above named

___________________ to me known to be (or who was presented to me to be) the person who executed the foregoing instrument

and acknowledged the same.

________________________________________________

Notary Public, State of Tennessee

My Commission Expires: ___________________________

Power Of Attorney