School Credential Release Authorization Form
Use this form to authorize a school to release credentials, records, or related academic information to a designated recipient.
Requester Information
Requester’s Full Name
*
First Name
Middle Name
Last Name
Relationship to Student or Graduate
*
Email Address
*
example@example.com
Phone Number
*
Please enter a valid phone number.
Format: (000) 000-0000.
Student or Graduate Information
Student or Graduate Full Name
*
First Name
Middle Name
Last Name
Date of Birth
*
-
Month
-
Day
Year
Date
School or Organization Name
*
Student or Graduate ID
Authorization and Release
Authorization Statement
I authorize the school to release the requested credentials or records to the named recipient
*
I authorize
Requester / Authorized Signer Signature
*
Submit Authorization
Submit Authorization
Should be Empty: