College of Education Permission to Release Form
California State University, Fullerton College Of Education Department of Secondary Education Permission to Release Information

NOTE: In the normal course of our programs, we will be asked by off-campus personnel for information about our students. In order to comply in a timely manner, we need your permission to release such information.

Please complete and sign the following form giving the department permission to release such information.

I, hereby authorize the Single Subject Credential Program to release the following information contained in my records at CSUF to any and all parties having an authorized relationship with the College of Education or the Single Subject Teaching Program (for example, CSUF faculty, representatives of state or national accrediting agencies or research firms, personnel from other education institutions, etc.):

Grades
TB Clearance Status with respect to program completion
Faculty evaluations of performance

Permission to release information is unconditional and exists as long as I am enrolled in the College of Education or seek employment for which reference from the Faculty of the College is requested by me or a prospective employer.


Please complete these forms by Saturday, August 19th at 5:00p.m.
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Email *
Program Subject Area *
CWID *
First Name *
Last Name *
Home Address (Street, City, State, Zip) *
Cell Phone Number *
I hereby acknowledge and understand the above information. I agree to comply with the provisions above. Your signature indicates that you have received a copy of this letter and have read and understand the conditions. Your typed name will be considered equivalent to your signature.
 *
Date *
MM
/
DD
/
YYYY
A copy of your responses will be emailed to the address you provided.
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