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~t~ jAJ1 - SACMsacm.org/pdf/openfilenewcompanion.pdf · ~.JrU\ t::u~ ~ ~I ~I.J 1-94 J~.ll\ •...

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Kingdom of Saudi Arabia jA"J1 U1.':1 Ministry of Higher Education Cultural Mission To The U.S.A. ...-'u..J1 ';.;1,)-, MlnJ.... ", 01' Educallt,m _ _ .ll\ . .) I .. a'JA r=w .1 cJ-!\yJ1.J jl-.H" 6-A .2 6.A 6.A 1-94 .J .Ji I.S:!jAi .ll.J u..J 6.A + r-!.) UJ.S:!) Ulb.: 0A .3 ,ul.hJ . . 1-20 0A .4 )'-"oIl \.).ll \ 0A .5 uLS Ijl. 4 W I '"jQ"a; " ¥ .6 I.S:!jAi .J uJ...a> Jkl-JA -.?-\ 0A .7 I+: 2600 Virginia Ave. , N.W. Suite 800 • Washington, D.C. 20037 • (202) 337-9450 • Fax: (202) 337-2978 Web Site: www.sacm.org • E·Mail: [email protected]
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Page 1: ~t~ jAJ1 - SACMsacm.org/pdf/openfilenewcompanion.pdf · ~.JrU\ t::u~ ~ ~I ~I.J 1-94 J~.ll\ • I.S:!jA~ J~.ll\ ~.J ~jA~\ ~\ j\~ o.)~ .Ji I.S ... Mission in Washington, D.C. to obtain

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Page 2: ~t~ jAJ1 - SACMsacm.org/pdf/openfilenewcompanion.pdf · ~.JrU\ t::u~ ~ ~I ~I.J 1-94 J~.ll\ • I.S:!jA~ J~.ll\ ~.J ~jA~\ ~\ j\~ o.)~ .Ji I.S ... Mission in Washington, D.C. to obtain

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CULTURAL MISSION OF THE ROYAL EMBASSY OF SAUDI ARABIA

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2600 Virginia Ave. , N.W Suite 800 • Washington, D.C. 20037 • (202) 337-9450 • Fa-x: (202) 337-2978 Web Site: www.sacrn.org • E-Mail: [email protected]

Page 5: ~t~ jAJ1 - SACMsacm.org/pdf/openfilenewcompanion.pdf · ~.JrU\ t::u~ ~ ~I ~I.J 1-94 J~.ll\ • I.S:!jA~ J~.ll\ ~.J ~jA~\ ~\ j\~ o.)~ .Ji I.S ... Mission in Washington, D.C. to obtain

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Kingdom ofSaudi Arabia ~~~I ~t)l.rl UJ..~I~i% Ministry ofHigher Educa.tion ~Wl ~I iJlj.J Cultural Mission To The U.S.A. ~jlfi'l i~1 ,,~~,,~ ~~I ~I~

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CONSENT TO RELEASE EDUCATIONAL RECORD INFORMATION

I , the undersigned hereby authorize the Royal Embassy of Saudi Arabia, Saudi Arabia Cultural Mission, In Washington, D.C. to obtain any information contained in my educational records from any educational institution, that I am attending or have attended.

Furthermore, I give permission to the Saudi Arabian Cultural Mission in Washington, D.C. to obtain any of my medical records (past and present) and legal records and (past and present) that they may need access to.

Please print your name in English (use a pen only)

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2600 Virginia Ave. , N.W Suite 800 • Washington, D.C. 20037 • (202) 337-9450 • Fax: (202) 337-2978 Web Site: www.sacm.org • E-Mail: [email protected]

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Kingdom ofSaudi Arabia ~,)~I ~~t UJ.,':I Ministry ofHigher Education ~la:l ~j i.)IjJ"'t'"Cultural Mission To TIle U.S.A. ~ ~Jo'~1 ~~t CJI:!~,r~ ~l.Ur1 ~I

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CONSENT TO RELEASE EDUCATIONAL RECORD INFORMATION

I , the undersigned hereby authorize the Cultural Mission OF THE ROYAL EMBASSY OF SAUDI ARABIA to the U.S.A. to obtain any information contained in my educational records from any educational institution that I am attending or have attended.

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