Form Ar-11 - Letter Of Authorization

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LETTER OF AUTHORIZATION /
FORM AR-11
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PLEASE COMPLETE THE FORM USING CAPITAL LETTERS/
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________________________________________________________ STUDENT NUMBER ___________________________
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–
GIVEN NAME / FAMILY NAME
AUTHORIZE: ____________________________________________________________________________________________
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–
GIVEN NAME / FAMILY NAME TO ACT AS PROXY ON MY BEHALF
RELATIONSHIP: ________________________________________________________________________________________
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: (e.g. MOTHER, FRIEND)
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/
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TO REQUEST FOR
TO PROCESS
CERTIFICATE OF STUDENT STATUS
MAINTAINING STUDENT STATUS
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in ENGLISH
in THAI
GRADUATION REGISTRATION
ACADEMIC TRANSCRIPT/GRADE REPORT (ENGLISH ONLY)
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RESIGNATION
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OTHER, ________________________________________________
Please specify /
READMISSION
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TO COLLECT
CHANGING PERSONAL INFORMATION
CERTIFICATE OF STUDENT STATUS
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OTHER, _____________________________________
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in ENGLISH
in THAI
Please specify /
ACADEMIC TRANSCRIPT/ GRADE REPORT (ENGLISH ONLY)
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DIPLOMA /
OTHER, _________________________________________________
Please specify /
I accept full responsibility for authorizing the above mentioned person. The university accepts no liability in the event of any
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dispute.
NAME ____________________________________________
NAME ___________________________________________
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/ THE AUTHORIZER
/ THE PROXY
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/
DATE
______/_________/________
DATE
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_________________________________________________________________________________________________________________
1.The authorizer must attach a signed copy of his/her identification card or passport, and the proxy must bring the
REMARK
original to show the officer at the registrar’s office.
2. The proxy must attach a signed copy of his/her identification card or passport, and must bring the original to
show the officer at the registrar’s office.
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THE OFFICE OF THE REGISTRAR, MAHIDOL UNIVERSITY INTERNATIONAL

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