Educational Institution Data Sharing Consent Form
Provide your consent for the sharing of educational data as described below.
Full Name of Student or Guardian
*
First Name
Last Name
Relationship to Student
*
Please Select
Self
Parent/Guardian
Other
Email Address
*
example@example.com
Phone Number
*
Please enter a valid phone number.
Format: (000) 000-0000.
Name of Educational Institution
*
Student ID (if applicable)
Please indicate the type(s) of educational data to be shared:
*
Academic Records (grades, transcripts)
Attendance Records
Disciplinary Records
Special Education Records
Health Records (as related to school)
Other
Purpose of Data Sharing
*
Please Select
Transfer to another educational institution
Government reporting/compliance
Research purposes
Educational support/services
Other
Recipient(s) of Data (Who will receive the shared data?)
*
Duration of Consent (How long is this consent valid?)
*
Please Select
One-time use only
Until the end of the academic year
Until revoked in writing
Other
Signature (Please sign below to confirm your consent)
*
Submit Consent
Submit Consent
Should be Empty: