Permission to Collect, Disclose, or Release Information
I, _______________________________________________________________ authorize the Student
(name of student)
Affairs office to release information regarding my education to ______________ _________
(name of parent, guardian, individual or agency )
This information is directly involved with my educational plan. Release of information to any other party is only
permitted with my written authorization.
give permission to release information
regarding admissions, academics, financial aid to the individual
or agency designated above;
allow the Office of Public Relations and Development at the College to release my name, photo, and/or
story in promotional materials for as long as deemed necessary for the advancement of the College and its purpose;
release the Student Affairs office and Williamsburg Technical College from all legal responsibility and liability
arising from disclosure of information based upon this signed release;
any information in my WTC records will remain confidential according to state and federal laws;
allow this release to remain in effect for one year of the signature date, or until I revoke it in writing, whichever
comes first. In all cases above I understand that I may revoke this consent in writing at any time.
receiving college updates via email or text messages.
_____________________________ _____________ ________________________
Student Signature Date WTC ID Number or Social Security Number
__________________________________________ ___________________
Signature of Parent or Guardian Date
Williamsburg Technical College is accredited by the Commission on Colleges of the Southern Association of Colleges and
s to award associate degrees. Contact the Commission on
Colleges at 1866 Southern Lane, Decatur, Georgia 30033-4097 or call 404-679-4500 for questions about the accreditation of Williamsburg Technical College. The Commission should be
contacted only if there is evidence that appears to support the colleges significant non-compliance with an accreditation requirement or standard.
SA 07.16
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