Sheridan ae national Add Agent to Student Record Last Name:_ ATUL Y AMOORTH First Name:_ GLOUT A AMANS Student Id: Date of Birth: (Ser aS/OS /(q9s Student Contact Info. (Email and phone number): Agent (Name, Company, Address, Email and phone number): : Anuchika Anrworty CAnushile Anthony Professional Comers¥on 26¢ Queen Street wost Bsamolon oN Lox (&/ QoS-Gterrol Anusniicr © AAVE Cawegers com Reason for adding Agent: 4 heertock-lhe opplicalion avl did Mob ill br muy Agent information dees CAG toe) Pak drrough te Ported: { como Q do Novell my application trough my agent Pursuant to s.39(1)(a) of the Freedom of Information and Protection of Privacy Act, 1Goathawan A 007 thy authorize The Sheridan College Institute of Technology and ced Learning to release information to the authorized agent listed above on this form. ‘Student Signature: Date of Request: This form is to be filled out by the student directly and emailed directly from the students’ Sheridan email address to international@sheridanc.on.ca ‘he Sheridan Catlege Inetitute of 905 245 9400 Technology and Advanced Learning 906 815 4008 140 Trafalgar Road sheriganeotageca loi, Ontario LH Lt intornational@sherdancallegecs