Fillable Authority 20 USC 1232g, and Public Law 93-380 (Lyon College)

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Authority 20 USC 1232g, and Public Law 93-380 (Lyon College)

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Authority 20 USC 1232g, and Public Law 93-380
Principal Purpose To authorize/decline the release of any and all official records maintained by the ROTC
Department to personnel in the Department of Defense and/or parents.
Routine Uses To provide authorization/declination to release information contained in official records.
Disclosure Disclosure is voluntary.
Having been advised of the provisions of Public Law 93-380 (20 USC 1232g, Family Educational Rights and
Privacy Act of 1974) and in connection with my participation in the Army ROTC program, I
hereby authorize the release of any and
all official records maintained by the
or it's ROTC Department to personnel in the Department of Defense and/or my parents,
.
I waive any requirement that I be furnished a copy of those records prior to or concurrent with their
release. This consent remains effective until my relationship with the ROTC program is terminated.
Signature of Cadet Date
Although informing my parents of the academic/ROTC progress made by me may assist in my quest to
become a commissioned officer, I decline to allow release of official records maintained by
ROTC Department to my
parents.
(Exception: Parents who still claim student as a dependent for IRS purposes)
If I change my mind in the
future, I will inform the ROTC Department in writing.
Signature of Cadet Date
CC FORM 137-R, AUG 02 PREVIOUS EDITIONS ARE OBSOLETE
AUTHORIZATION/DECLINATION FOR ACCESS TO STUDENT RECORDS
For use of this form, see CC Pam 145-4, the proponent agency is ATCC-PC
DATA REQUIRED BY THE PRIVACY ACT OF 1974
PART II - DECLINATION OF PARENTAL ACCESS TO STUDENT RECORDS
(Name of School)
(Name of School)
(Name of Parents)
(Cadet's Name)
PART I - AUTHORIZATION FOR ACCESS TO STUDENT RECORDS
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Authority 20 USC 1232g, and Public Law 93-380 (Lyon College)

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Completed 23 July 2020

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