AMERICAN UNIVERSITY OF BEIRUT
REGISTRAR’S OFFICE
PO BOX 11-0236
Riad El Solh, 1107 2020
Beirut, Lebanon
I,_____________________,born on ,_________________________ , hereby give permission to
Full Name
____________________________________________________ to release information regarding
Name of Institution from which highest degree was granted
my academic credential to the Registrar’s Office at the American University of Beirut.
My current contact information is as follows:
Home Address :
__________________________________
__________________________________
AUB Telephone
Number and Ext.:
_____________________________
Mail Box:
_____________________________
Mobile Number:
__________________________________
Email address:
__________________________________
Signature _________________________________
Date ____________________________________