Student Life Counseling Office
Authorization Letter for Personal Data Application

Name of Authorizer	Student ID of Authorizer	Category of Application Form	Signature of Authorizer
□Type I Application Form □Type II Application Form
□Type I Application Form □Type II Application Form
□Type I Application Form □Type II Application Form
□Type I Application Form □Type II Application Form
□Type I Application Form □Type II Application Form
□Type I Application Form □Type II Application Form
□Type I Application Form □Type II Application Form
□Type I Application Form □Type II Application Form
□Type I Application Form □Type II Application Form
□Type I Application Form □Type II Application Form
□Type I Application Form □Type II Application Form
□Type I Application Form □Type II Application Form
□Type I Application Form □Type II Application Form
□Type I Application Form □Type II Application Form

Department Responsible Person’s Approval (Seal)	Department Head’s Approval (Seal)

Date (Republic of China)

Year ______ Month ______ Day ______