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LOUISIANA DELTA COMMUNITY COLLEGE
Division of Student Affairs Department of Enrollment Services
Authorization for Release of Information
FOR RELEASE OF GRADE(S), ACADEMIC ENROLLMENT
STATUS, ATTENDANCE AND FINANCIAL
I hereby authorize Louisiana Delta Community College (LDCC) to release my academic and
enrollment status, class schedule, attendance, financial and other related information to my
parent(s), or named individuals or entities listed below.
I understand that by signing this authorization, I am waiving my rights of nondisclosure these records under
federal law only to the persons specifically listed above. This release does permit the disclosure of these
records to any other person(s) or entities without my
Enrollment Services use only
Form of ID Identity Verified By:
Date:
Name
Relationship
Address
City, State, Zip
Email
Student Name: (Print)
St
Student ID Number:
Date:
__________________ ________________________________
______________________
Please
City, State,
Email
