U.S. Passport Office

Dear Passport Representative:

I, ____________________________, ..............__________________________
.........(Print Child’s Name) ...........................................(Print Parent’s Name)

authorize your office to discuss the status of my application and release my passport to
PVS International.

Thank you for your assistance.

Respectfully,

__________________________
(Print/Sign Child’s Name)

__________________________ .................._______________
(Parent’s Signature)........................................ Date

Applicant’s Date of Birth: _____________

Date of Departure from USA: _____________