Electronic Signature Consent Form

I am giving my consent to (INSERT NAME OF FACULTY, USE

MR/MS/MRS/DR), course instructor/professor, to use my e-signature
attached to this form for my acknowledgement of the course
syllabus on (INSERT the Course, e.g. CBE1 – General Education)
and be contain on FM-AA-CIA-04 QMS FORM (Acknowledgment Receipt
of Syllabi by the student) this INSERT SEMESTER. 

By signing this Electronic Signature Consent Form, I agree that

my electronic signature is equivalent to my handwritten signature
and shall only be used as stated above.

                        
              
   NAME (AL CAPs and BOLD)                  DATE
  Signature over Printed Name of Student          Date Signed