Authorization For Release Of Student Information {SF-8}

Form SF-8 Rev. 1-1-2001 Autho rity: Ark. Code Ann. §11-9-527(d)(2) ARKANSAS WORKERS' COMPENSATION COMMISSION SPECIAL FUNDS DIVISION 324 Spring Street, P. O. Box 950, Little Rock, AR 72203-0950 501-682-5187 / 1-866-880-8444 (Toll-free) SF-8 AUTHORIZATION FOR RELEASE OF STUDENT INFORMATION Attention: Registrar's office I, (print full name) , a student at your institution, do hereby authorize you to furnish copies of any and all records pertaining to my enrollment at (institution name) at (City) (State) (Telephone) to the Arkansas Workers' Compensation Commission, Death and Permanent Total Disability Trust Fund, at the above address, and also to provide such information by telephone to employees of the Trust Fund upon their request. A photostatic copy of this authorization shall be as valid and effective as the original at any time hereafter, unless revoked by me in writing. Dated the ______ day of ______________________, 2________. Signed: _________________________________________ Social Security Number: _______________________________________ Student ID No.: _________________________________________ Date of birth: _________________________________________ Address: _________________________________________ City, State, ZIP: _________________________________________ SF-8 American LegalNet, Inc. www.FormsWorkFlow.com