Marine Welding Level 1 Program Release of Information Form
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Full Name *
Former Name(s)
Date of Birth *
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The records to be disclosed are Information from your PDCCC Noncredit Application Form: Permanent records (grades, certifications); Financial Aid; Other: (i.e., attendance, program completion date, etc. for the Marine Outside Machinist Pre-Hire Certification Noncredit Training) *
Required
The above information will be disclosed to a designed person at: Name of third party: Virginia Ship Repair Association; Address of third part: 150 Boush St #802, Norfolk, VA 23510; email: snikitas@virginiashiprepair.org *
Required
Signature of Student *
Date *
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