Remove Authorized Persons from Receiving My Student Information
Remove This/These Previously Authorized Person(s) from Receiving
My Student Information:
1.
2.
3.
Solomon Amendment
Under Public Law 104-208, Cascadia College is directed by the federal government to
provide the Armed Forces information such as name, address, phone, birthdate, level of
education, major and/or degree received, and prior military experience for all students.
If you do not wish this information to be released, check mark Do Not Release
Information and sign this form. This request will prohibit your name from being
published in all college-related publications.
Do Not Release Information
Student Authorization
I, (name)
authorize Cascadia College to release information to the authorized person(s) as
specified above. I understand that this Release of Information is valid until I withdraw
the Release in writing or graduate from Cascadia. I understand that the Release of
Information does not allow information to be released over the phone and does NOT
allow or authorize any changes to my student record by any other individuals.
Student Signature Date Signed
Cascadia College is an equal opportunity institution and does not discriminate on the
basis of race, color, religion, gender and/or sex, disability, national origin, citizenship
status, age, sexual orientation, veteran’s status, or genetic information. All Cascadia
materials are available in alternative formats and can be requested by contacting the
Human Resources Office.
Office Use Only
ES Received By Date
System Logged SSS Drive
