Tame: Texas Alliance For Minorities in Engineering

AUTHORIZATION TO RELEASE GRADES

TO AGENCIES PROVIDING FINANCIAL SUPPORT

NAME: First MI Last:

STUDENT ID#:

I hereby authorize the Office of the Registrar at the following college or university, to release my courses, grades, grade point averages and scholastic status at the end of the semester, for the year . Please send a copy of my cumulative grade report to the following agency which is providing financial support for my education:

Texas Alliance for Minorities in Engineering, Inc.

UT-PRC

10100 Burnet Road, R9200

Bldg 16, Room 10

Austin, TX 78758

I understand that my courses, grades, grade point averages and scholastic status may be made available to the Industry Sponsor (if financial support was provided by an Industry Sponsor) and by signing below I am agreeing to make my courses, grades, grade point averages and scholastic status available to the following Industry Sponsor:

____________________________________________________________________________________

Student's signature Date

Student's current telephone number