To: International Admissions Advisor

Registrar’s Office
Trent University
Peterborough, ON
Canada K9L 0G2
E-mail: internationaladmissions@trentu.ca
Fax: 1-705-748-1629

Re: Consent to release personal information and documents

I,____________________________________, hereby confirm the appointment of

(name of the student)
_________________________________________________
ApplyBoard Inc as my official agent and
(name of the agency)
authorize them to act on my behalf in all matters related to my admission to Trent
University. I consent to the release of information regarding my admission application to
Trent University and matters related to my admission to Trent University.

I certify that I have been provided with counseling services on Trent University and have
been assisted with my admission application to Trent University.

This consent and authorization will be effective for a period of one year unless revoked in
writing.

Dated this ____day of _________, _________ ______________________________

(day) (month) (year) (signature of the student)

Massi Basiri
_____________________________________________
(name of the witness/agent)