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