Document Pick up Authorization

Please complete this form if you wish to authorize a friend, who can meet the criteria set forth herein, to pick up a document from the International Center on your behalf.

Your information

This information must match exactly the name on the documents to be picked up
Your Name * First Last
Please enter your name as it appears on your immigration documents.
Your A# *
Email *

Illinois Tech email address
Immigration Status: *

Immigration Status: F-1 (Including OPT) J-1 (Including Academic Training) Other Other
Document(s) to be collected *
OPT I-20 CPT I-20 I-20/DS-2019 for travel Dependent I-20s/DS-2019s Program Extension I-20/DS-2019 Academic Training DS-2019 Proof of Residence Letter Social Security Letter Other Other
Please use "Other" for documents not listed and specify what document is to be collected.
Classification: *

Classification: Undergraduate student Graduate student Scholar Alumni (including OPT)
Authorized person collecting documents

Person collecting documents must show a photo ID that matches the information below.
Authorized Person * First Last
Authorized Person's Email Address *
Authorized Person's A# or SEVIS Number *
ASSUMPTION OF RISK AND RELEASE
By clicking below I authorize the above named person to pick up my document(s) at the International Center and expressly agree that the Illinois Institute of Technology may rely on this authorization. I understand and acknowledge that documents may include personal, academic, and/or immigration information and include personally identifiable information. I hereby freely assume any and all risk of any kind associated with this authorization, and I knowingly release, to the fullest extent allowed by law, Illinois Institute of Technology, its trustees, officers, employees and agents, from any and all claims arising from the loss, damage or destruction of my documents and the unauthorized review, release or use of the data included therein. *
I have read and agree to these terms.
Draw your signature into the box below. *

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Document Pick up Authorization

Document Pick up Authorization

Your information

Authorized person collecting documents

ASSUMPTION OF RISK AND RELEASE