Mississippi Baptist Foundation
Thursday, April 24, 2014

6. Release of Information Form

I attest that the information given is true and accurate to the best of my knowledge and hereby authorize release of academic or financial information necessary for the review of this application.

___________________________                    ______________________
Applicant's Signature                                          Social Security Number
 
 
AUTHORIZATION FOR RELEASE OF CONFIDENTIAL STUDENT INFORMATION
 
I ________________________________________, whose Social Security Number is ________________________________, do hereby authorize the release of academic or financial information from ______________________________________ (name of your college or seminary).
 
To:  The Mississippi Baptist Foundation
       P. O. Box 530, Jackson, MS  39205
 
Signed ______________________________________                        
 
 
Date _____________________
 
 
Phone Number ___________________________________