Fillable Ecp Student Consent Release Formflbl (Eastern Idaho Technical College)

Fill Online, Printable, Fillable, Blank Ecp Student Consent Release Formflbl (Eastern Idaho Technical College) Form

Use Fill to complete blank online EASTERN IDAHO TECHNICAL COLLEGE pdf forms for free. Once completed you can sign your fillable form or send for signing. All forms are printable and downloadable.

Ecp Student Consent Release Formflbl (Eastern Idaho Technical College)

On average this form takes 8 minutes to complete

The Ecp Student Consent Release Formflbl (Eastern Idaho Technical College) form is 1 page long and contains:

  • 1 signature
  • 15 check-boxes
  • 22 other fields

Country of origin: US
File type: PDF

U.S.A. forms for Eastern Idaho Technical College

BROWSE EASTERN IDAHO TECHNICAL COLLEGE FORMS

Related forms
Fill has a huge library of thousands of forms all set up to be filled in easily and signed.
Fill in your chosen form
Sign the form using our drawing tool
Send to someone else to fill in and sign.
find another form
 
For CEI use only: Revised 11.28..18
☐ EC Verified ☐ Sponsorship Entered (BO Office) ☐ Early College Programs Office (Perc added)
Early College Programs Student Consent for Release of Non-Directory Information
College of Eastern Idaho Records Policy, in compliance with the Family Educational Rights and Privacy Act of 1974
(FERPA), requires the written consent of the student authorizing the disclosure of non-directory information from his or
her record. The authorization must include: the specific information to be released; the party or class of parties to whom the
information is to be released; the purpose of the release; the date; and the student’s signature.
PHOTO ID IS REQUIRED. Students must present photo ID when submitting this form in-person, or provide a copy of
photo ID when submitting the form via mail, fax or email.
(PRINT or TYPE All Information CLEARLY, Using Ink Only)
1. Student Contact Information
Name
Date
Student ID#
Phone
Date of Birth
2. Release Education Record Information to (Recipient):
Last Name
First Name
Organization/School
Relationship
Address
City
State
Zip
3. Type of Release (Check one):
☐ One-time release of student records.
☐ Release of student records until revoked by me in writing and delivered to CEI.
(Note: if you have signed a confidentiality request for your directory information, you must submit a one-time
only release for each release of information.)
☐ I wish to revoke the current release of information I have on record for the following
person/institution:
4. Education Record to be Released (Check all that apply):
☐ Attendance
☐ Billing Statements
☐ Class Schedule
☐ Financial Aid
☐ Grades/GPA
☐ Program Information
☐ Status Information
☐ All of the Above
☐ Other- please specify
5. Signature
I give permission to College of Eastern Idaho (CEI) to release the specified information to the recipient listed above. I
understand that this information is considered part of a student education and/or financial record. Further, I understand
that by signing this release I am waiving my right to keep this information confidential under the Family Education
Rights and Privacy Act (FERPA). I certify that my consent for disclosure of this information is entirely voluntary.
I understand this consent for disclosure of information can be revoked by me in writing at any time, but will not affect
the information released under my previous consent. If I wish to make any changes to my consent for release, I
understand I will need to complete and file a new form.
Student Signature
Date
For CEI Use Only
Initial
Dept.
Date
Note: by signing this you are confirming that you have verified photo ID. After entering the release of information in
Colleague, have the form scanned and place in students file.
Return this completed page to
Early College Programs
click to sign
signature
click to edit
Download
Save PDF to desktop
Email
Email completed PDF
Send for Signing
Email for others to sign
Print
Print document
Choose a Field
Click on a field and
select the person that should complete it
Want to add a signature?
You can add a signature field
and assign it to someone else
to sign
Choose a Field
Click on a field and
select the person that should complete it

Ecp Student Consent Release Formflbl (Eastern Idaho Technical College)

This document is locked as it has been sent for signing.

You have successfully completed this document.

Other parties need to complete fields in the document. You will recieve an email notification when the document has been completed by all parties.

This document has been signed by all parties.

Completed 26 July 2020

Message

View Audit Log
Print With Audit Log
Duplicate Document