美国乔治•梅森大学1+2+1项目
公开中方学生资料协议

我________________________   G# ________________________
          姓名（打印）

完全接受学校1+2+1项目协调员将我的学生信息给中教国际教育交流中心和我的中方大学。

我的签字证明：我明白这个协议是我作为美国维吉尼亚州费尔法克斯市的美国乔治•梅森大学整个阶段都是有效的。

我也明白美国乔治•梅森大学1+2+1项目中方学生的照片或许会用在1+2+1的材料上，我允许我的照片用在这些材料里（如果不允许，请在这个方框中注明: [  ] )。

______________________________  ____________________
* 学生签字                           日期

_______________________________  ____________________
  学校中国1+2+1协调员签字                日期

*本表应是学校中国1+2+1项目协调员、学院或公证人在场时签字，以确保签字的真实行。
*更多家庭教育权利和隐私权信息，请查看网站：
http://www.registrar.gmu.edu/privacy/ferpa/html

                                                                                                            current 10/06
Student Release Form:  U.S.-China 1-2-1 Students

I ________________________        G# ________________________
          print full name
fully authorize the Coordinator of the China 1-2-1 Program to release my student records to the China Center for International Educational Exchange (CCIEE) and to my home educational institution in China.
I attest to the signature below and understand that this authorization is valid for the entire period while I am enrolled as a student at George Mason University in Fairfax, Virginia.
I also understand that photos of Mason’s 1-2-1 students may be used in 1-2-1 materials developed at Mason or in China, and I give permission for my photo to be used in such materials. (To refuse permission, please indicate with a check in this box:.   [  ] ).
_________________________________________  ____________________
* Student Signature         Date
_________________________________________  ____________________
   Signature of China 1-2-1 Coordinator       Date
* This form must be signed in the presence of the China 1-2-1 Coordinator, a university official, or a notary public qualified to certify the authenticity of the signature.
For more information about the Family Education Rights and Privacy Act, see
http://www.registrar.gmu.edu/privacy/ferpa/html