Admissions and Registration
901 N Colombo Ave
Sierra Vista, AZ 85635-2317
FOR OFFICE USE
COPY FOR STUDENT
DATE & INITIALS_____________________
AUTHORIZATION FOR RELEASE OF INFORMATION
THIRD-PARTY DESIGNEE INFORMATION (Individual or Agency to whom access is granted)
LENGTH OF RELEASE
One time use: This authorization can be used only once.
One semester: This authorization will remain in effect through __________Term ________Year.
One year: This authorization will remain in effect unless I withdraw this authorization or for a maximum of one year.
PURPOSE FOR THE AUTHORIZATION FOR RELEASE OF INFORMATION:
Admissions & Records – Admissions application, grades, registration & schedule information, residency information,
transcripts, student ID, and related information
Financial Aid – Financial Aid application documents, status, satisfactory academic progress, awards and related
Student Finance – Student account invoices, statements, payments, charges, credits, tax forms (including 1098T),
and related information.
Counseling, Academic Advising, Testing & Disability Support Services
Faculty – Letters of recommendation, grades, attendance, and related information
No limitation – share anything and everything
I understand that my records are protected under the Family Educational Rights and Privacy Act of 1974 and cannot be
released without my written consent. I hereby waive all provisions of the law and privilege relating to the records
described in this disclosure. I certify that this consent has been given freely and voluntarily. I may revoke this consent at
any time by providing written notice to the Admissions and Registration office.
This form must be presented along with government issued photo ID and signed by the student in front of an
authorized Cochise College employee.