Fillable PTA Release Of Information (Indian Hills Community College)

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PTA Release Of Information (Indian Hills Community College)

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Country of origin: US
File type: PDF

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Release of Information
I consent that Indian Hills Community College may release the following to health care facilities for potential
employment evaluation purposes:
Attendance Record Yes No
Grade Point Average Yes No
Instructor Evaluation Yes No
I consent that Indian Hills Community College may release the following to employment recruiters:
Name Yes No
Home Address Yes No
Email Address Yes No
Phone Number Yes No
I consent that Indian Hills community College may request information regarding my job performance from
employers and consumers for program assessment purposes.
Yes No
Name:
Signature: Date:
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PTA Release Of Information (Indian Hills Community College)

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Completed 18 July 2020

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