2930 Wetmore Avenue, Ste. 9D Everett, Washington 98201 Phone: (425) 259-6515 Fax: (425) 259-7152

privacy release and submitted with it; and 3) all of this information is complete, true, and correct. I, (print your name) _____, authorize USCIS to release information contained in my USCIS records as relevant to checking my case status, and to the extent permitted by law, to Congresswoman Debbie Kirsten Gillibrand | U.S. Senator for New York The official website of U.S. Senator Kirsten Gillibrand. Proud to serve New York in the United States Senate. Help With A Federal Agency | How Can I Help? | U.S Rock Island 1823 2nd Ave., Suite 2 Rock Island, IL 61201 Phone (309) 606-7060 Fax (309) 786-1799 Directions Privacy Policy and Release Form If a third party calls the Accounting Services Office to make a payment on a student's account and the third party is not on the student's privacy release or the student is not able to give verbal approval, the third party will not be able to make a payment.

I, the undersigned, hereby authorize the release of all pertinent information to and by Congressman Scott or any authorized member of his staff to make an inquiry on my behalf. Signature: _____ Date: _____ Please print and return signed form by fax or mail to: Fax: (770) 210-5673

language translations are acceptable to facilitate completion of the form in English. U.S. Department of State Place of Birth I hereby authorize the U.S. Consular Office of the United States of America and the U.S. Department of State to release information regarding me to the following individuals : SECTION A Rock Island 1823 2nd Ave., Suite 2 Rock Island, IL 61201 Phone (309) 606-7060 Fax (309) 786-1799 Directions

I, the undersigned, hereby authorize the release of all pertinent information to and by Congressman Scott or any authorized member of his staff to make an inquiry on my behalf. Signature: _____ Date: _____ Please print and return signed form by fax or mail to: Fax: (770) 210-5673

Find out which VA insurance programs may be right for you and the form you need. Department of Defense (DOD) forms . Search for DD forms and instructions at the official DOD forms website. Contact the VA forms managers. Can’t find the VA form you’re looking for? Contact us.