Enrollment Assistance Authorization Form
Complete this Enrollment Assistance Authorization Form to authorize a representative for the enrollment tasks you select.
Applicant full name
*
First Name
Last Name
Applicant email
*
example@example.com
Applicant phone
Please enter a valid phone number.
Format: (000) 000-0000.
Institution and program applying to
*
Authorized representative full name
*
First Name
Last Name
Representative email or phone
*
Enrollment assistance tasks authorized
*
Completing application steps
Submitting enrollment documents
Communicating about enrollment status
Other enrollment-related assistance
Authorization effective date
*
 -
Month
 -
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Applicant signature
*
Submit Authorization
Submit Authorization
Should be Empty: