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Authorization to Release Academic Information Form
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* Indicates required question
Email
*
Your email
Authorization to Release Academic Information Form
Student First Name
Your answer
Student Last Name
Your answer
Student Middle Name
Your answer
Grade Level
*
9
10
11
12
High School
Your answer
Date of Birth
MM
/
DD
/
YYYY
Parent/guardian Name:
Your answer
Consent to release information to schools or employers where student has already applied
I consent
I do not consent
Clear selection
Consent to release information to schools or financial aid providers where student has NOT already applied
I consent
I do not consent
Clear selection
Student Signature - enter initials
Your answer
Date
MM
/
DD
/
YYYY
Parent/Guardian Signature (required if Student under 18) - enter initials
Your answer
Date
MM
/
DD
/
YYYY
Submit
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