Student Consent To
Release Confidential Information
(To be retained in student file in the Records Office)
STUDENT NAME (Please Print) AIMS ID OR DATE OF BIRTH
YOU MUST ANSWER ALL 3 SECTIONS LISTED BELOW
1) Records to be disclosed (please be specific): Choose only ONE option of either A, B, or C
A
) Course Schedule Grades/GPA Tuition Balance/Payments Financial Aid Status
OR
B
) Release only the following information from my educational records (be specific):
.
OR
C
) Release all educational records/information.
2) Persons named in this release can access records indicated above in two ways:
1. In person. Visit the Student Enrollment Office at any campus
and present a photo ID.
2. Over the phone. Caller must identify his or her self and provide security code. If no security code is provided,
no information will be released.
Person/Organization to whom information is to be released:
Name: Name:
Relationship to Student: Relationship to Student:
*Security Code: *Security Code:
*This code must not be the student’s myAims password or date of birth. Assign a unique security code to each person
named in this release. We recommend the security code be at least six characters long and include a combination of
letters and numbers.
3) Release is valid for a maximum of one full calendar year unless revoked by student in writing.
If less than one year, authorization to release expires (date):
(If left blank, authorization to release expires one year after signing.)
By signing below, I am authorizing Aims Community College officials to release to the person/organization
specified above the information specified above for the time period I have indicated.
Student Signature Date
Return this form to the Student Enrollment Office in person, by mail, fax, or scan and email.
By mail: Aims Student
By fax: 970.506.6958 By email: admissions@aims.edu
Enrollment & Records Office
PO Box 69
Greeley, CO 80632
Please refer to the current Aims Community College Catalog for information regarding the release of information. In compliance with the
Family Education Rights and Privacy Act (FERPA) regulation 34 C.F.R. part 99.30, the disclosure of information from a student’s education
record requires the parent or eligible student to provide signed and dated written consent before Aims Community College discloses
personally identifiable information from the student’s education records, except as provided in section 99.31.
Release of Confidential Information – revised 09/19/2018
click to sign
signature
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