Authorization For Release Of Student Information
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Authorization For Release Of Student Information Form. This is a Arkansas form and can be use in Workers Comp.
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Tags: Authorization For Release Of Student Information, SF-8, Arkansas Workers Comp,
ARKANSAS WORKERS’ COMPENSATION COMMISSION
Form SF-8
Rev. 1-1-2001
SPECIAL FUNDS DIVISION
Autho rity:
Ark. Code Ann.
§11-9-527(d)(2)
SF-8
501 Woodlane, Ste 101, Little Rock, AR 72201
501-682-5187 / 1-866-880-8444 (Toll-free)
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
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