Date: __________________

　

TO WHOM IT MAY CONCERN:

I, _______________________________, (Social Security No.____________

 and / or Student ID No. ________________ ) hereby waive my rights under

 the Rights of Privacy Act and authorize the release of all information

 relevant to my academic record at ______________________________ to

Taipei Economic & Cultural Office in Los Angeles at 3731 Wilshire Blvd.,

 Suite 700,  Los Angeles, CA 90010

　

Sincerely Yours,

　

________________

(Signature)