Student Education Records Release Authorization Form
Authorize the release of your education records by completing this secure form.
Student Full Name
*
First Name
Last Name
Student Email Address
*
example@example.com
Recipient Name or Organization
*
Recipient Email or Contact Information
*
Records to Be Released
*
Transcripts
Enrollment Verification
Attendance Records
Disciplinary Records
Other
Purpose of Release
*
Please Select
Transfer to another school
Employment
Scholarship application
Personal use
Other
Date of Authorization
*
 -
Month
 -
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Signature of Student
*
Submit Authorization
Submit Authorization
Should be Empty: