Contract of Participation & Release Waiver
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Please print your name giving permission to North Carolina Wesleyan College to release any and all information regarding my academic record to the individuals on this form. *
Name of first individual to whom information can be released: (Please make sure you put their first and last name, relationship to you, his/her home address, his/her home phone, his/her work address, his/her work phone, and email address) *
Name of second individual to whom information can be released: (Please make sure you put their first and last name, relationship to you, his/her home address, his/her home phone, his/her work address, his/her work phone, and email address)
Please print your name in lieu of your signature if you are in agreement with: I understand that this authorization for release of information will remain in effect through my academic career at North Carolina Wesleyan College unless I personally request, in writing, that this authorization be invalidated. I also understand that information concerning my academic progress includes, but is not limited to, my grades, my probationary standing, my progress concerning agreements that I have made with college personnel and other similar information: *
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