Page 1 of 1
ONE-TIME MEETING RELEASE FORM
Student Name: _________________________________________________________________
Last First Middle
Address: ______________________________________________________________________
Street
______________________________________________________________________
City State Zip Code
Phone Number: ( ) -
Student ID: Date of Birth: / /
Month Day Year
I, ___________________________, give my permission for ____________________________
Print Student Name Print Participant Name
to be present during the meeting held on _____/_____/______. I am requesting the presence
of the aforementioned participant for the purpose of ________________________________
_____________________________________________________________________________.
I understand that this form is invalid absent a student and participant ID verified by the faculty or
staff member hosting the meeting dated above. I acknowledge that questions posed by me may be
freely answered by the faculty or staff member and that questions posed by the participant will not
be answered without my approval. This form is valid only during the meeting specified above and
does not extend to any type of phone or electronic conversations or subsequent meetings related
or unrelated to the above stated purposes of attendance.
STUDENT SIGNATURE DATE
PARTICIPANT SIGNATURE DATE
--------------------------------------------------------------------------------------------------------------------------------------------
FACULTY/STAFF-
Student Photo ID checked: Yes No Initials: ___________
Participant Photo ID checked: Yes No Initials: ___________
click to sign
signature
click to edit
![]()
click to sign
signature
click to edit
![]()
