AUTHORIZATION TO RELEASE INFORMATION FORM​

Authorization to Release Information Form
The following information is required by the Family Educational rights and Privacy Act of 1974 (FERPA), as amended in the order for the college to be authorized to release the information that you indicate. This procedure is strictly followed to protect your privacy.
hereby authorize Omnitech Institute to release information from my academic or financial file as indicated and any other record pertaining to me to the below listed person(s). I understand and agree that this release will encompass my entire academic career at Omnitech Institute. I may change this permission at any time by completing a new “Authorization to Release Information Form” at which any prior forms signed become null and void.

In addition, I understand that the person(s) listed below will be asked to verify my social security number and date of birth prior to any information being released.

Individuals/ Agency authorized to receive my personal information

I do not grant permission to anyone to receive personal information pertaining to me
I grant permission of my personal information to be shared with the following individuals/agencies:
I grant permission of my academic information to be shared with the following individuals/agencies: