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CBU Consent Form

This document is a Third Party Letter of Authorization allowing World Immigration Consultants to submit an application on behalf of the student, M. Sravani, to Cape Breton University. It includes consent for the release of personal information related to the application and acknowledges conditions that may affect the application status. The student confirms the truthfulness of the provided information and agrees to the university's policies regarding document handling and potential changes to services.

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37 views4 pages

CBU Consent Form

This document is a Third Party Letter of Authorization allowing World Immigration Consultants to submit an application on behalf of the student, M. Sravani, to Cape Breton University. It includes consent for the release of personal information related to the application and acknowledges conditions that may affect the application status. The student confirms the truthfulness of the provided information and agrees to the university's policies regarding document handling and potential changes to services.

Uploaded by

kavalikishore34
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
Available Formats
Download as DOCX, PDF, TXT or read online on Scribd
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P.O.

Box
5300, 1250 Grand Lake
Road, Sydney, NS
Canada B1M 1A2
[email protected]
Tel: 902-563-1330

OFFICE OF
REGISTRAR AND
ADMISSIONS

Third Party Letter of Authorization for Submission of Application


and
Consent to Use and Disclosure of Personal Information and Conditions of
Application

I. AUTHORIZATION

I M.Sravani (student name) hereby authorize World Immigration Consultants (Agent) to act on my
behalf to complete and submit an application on my behalf to Cape Breton University and carry out
all acts related to my application and admission to Cape Breton University. I understand and
agree that I will be bound by any acts carried out by the Agent on my behalf and such acts will
have the same effect as if they were performed by me.

This authorization is valid for one (1) year from the date of signature, unless Cape Breton University
receives further written notice from me extending or rescinding this authorization.

II. CONSENT TO USE AND DISCLOSURE OF PERSONAL INFORMATION

I hereby authorize the release of my admissions status, name, student number, citizenship,
enrolment status, program and confirmation of tuition paid, to the Agent (or any other agent
designated by me) and to M Square Based Solutions Limited (MSM) upon submission of my
application to Cape Breton University and while enrolled as a student at Cape Breton
University.

III. CONSENT TO CONDITIONS OF APPLICATION

By signing this document, I also acknowledge the following conditions to the application to
Cape Breton University submitted on my behalf:

I agree that failure to list and provide previous, in-progress or completed transcripts from all
institutions I attended on the application may be considered an intentional omission and can
lead to the cancellation of my application for admission or withdrawal of my offer of admission.

I agree that details concerning my application, enrollment, or any falsification of information


may be provided to other institutions including the Association of Registrars of the
Universities and Colleges of Canada, in accordance with the Freedom of Information and
Protection of Privacy Act.

I understand that by submitting an application, I consent to the sharing of the information


supplied with faculty and staff who are facilitating my success at Cape Breton University. I
understand that if I enroll in a co-operative program, I consent to the release of my
academic record to prospective employers.

I agree that supporting documents submitted to Cape Breton University are recorded and
shredded to protect privacy and will not be returned under any circumstances. Further, neither
the documents nor copies of the documents will be issued to third parties. Cape Breton
University reserves the right to request an original document from the issuing institution.
I agree that Cape Breton University reserves the right, without liability or penalty and without
notice, to make changes to its policies and offered services and programs, including alteration of
fees, cancellation of particular courses and changes to financial policies including the Refund
Policy. Every student accepted for registration in Cape Breton University shall be deemed to
have agreed to any such changes, whether made before or after said acceptance.

I confirm that all information submitted in the application is my own, factually true, and honestly
presented. I authorize review of my application. I authorize all schools/institutions attended to
release any requested records. I understand that I may be subject to a range of possible
disciplinary actions, including withdrawal of my offer of admission or dismissal, should the
information I confirmed be false.

Full Name: (printed) Mengini Sravani

Signature: (must be with pen, e-signatures are not acceptable)

Date:

WITNESS - Full Name: (printed) Kavali Kishore

Signature: (must be with pen, e-signatures are not acceptable)

Date:
P.O. Box 5300, 1250 Grand Lake Road, Sydney, NS Canada
B1M1A2
Revised: 10-March-2023, Office of the Registrar

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