Educational Power of Attorney Revocation Form
Revoking Individual (Principal) Information
Full Name
Address
Phone Number
Email
Attorney-in-Fact Information
Full Name
Address
Educational Institution
Name of School or Institution
Details of Power of Attorney Being Revoked
Date Original Power of Attorney Was Signed
Additional Details or Reference Number
Revocation Statement
Statement
Signatures
Signature of Principal
Date
Notary Section (if applicable)
Notary Public Name
Notary Public Signature
Seal
Date