WILLIAMSBURG TECHNICAL
COLLEGE
INFORMATION RELEASE FORM
Permission to Collect, Disclose, or Release Information
PLEASE PRINT
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.
AND I AGREE TO
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
School
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 college’s significant non-compliance with an accreditation requirement or standard.
SA 07.16
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