Consent_To_Release_Student’s_Information

Consent to Release Information

"*" indicates required fields

Phone

This field is for validation purposes and should be left unchanged.

All information contained within this document shall be treated as confidential. Casa College will not disclose information about students to third parties, other than designated “directory information,” without the student’s prior written consent, except where disclosure is permitted or required by law and institutional policy. Students may authorise the College to release their education records to specified individuals by completing and submitting this consent form, in accordance with College regulations. Please note that consent may be withdrawn at any time by providing written notice to the College.

File No.:*

Date:*

PERSONS TO WHOM CASA COLLEGE IS AUTHORISED TO RELEASE ACADEMIC RECORDS AND OTHER INFORMATION

Please provide information for up to two (2) people

Person 1:

First Name:*

Last Name:*

Relationship: (ex: father, mother, sibling, etc.)*

Phone No.:*

Email:*

Address:*

Street Address City ZIP / Postal Code Country

Person 2:

First Name:*

Last Name:*

Relationship: (ex: father, mother, sibling, etc.)*

Phone No.:*

Email:*

Address:*

Street Address City ZIP / Postal Code Country

Please specify what type of information we can provide:

Attendance

Midterm Exam's Results

Final Exam's Results

Retake Exam's Results

Medical Problems

Other

Please specify:*

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Consent to Release Information

PERSONS TO WHOM CASA COLLEGE IS AUTHORISED TO RELEASE ACADEMIC RECORDS AND OTHER INFORMATION

Person 1:

Person 2:

Casa College

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