Permission to Release Education Records
In compliance with the federal Family Educational Rights and Privacy Act of 1974, Georgia Northwestern
Technical College is prohibited from providing certain information from your students to a third party, such as
information on grades, billing, tuition and fees assessments, financial aid, and other student record information.
This restriction applies, but is not limited, to your parents, your spouse, a friend or a sponsor.
Student’s Last Name First Middle
Student ID# or Social Security# Date of Birth
Address City State Zip
Email Phone
Release my information to Last Name First
Relationship to student
By signing this waiver, I give the individuals listed above permission to have access to my educational records. I
understand they will have to confirm my identity with the information listed above in order to have access to
my records.
Student signature Date
Return this form in one of the following ways: Email to the Registrar’s Office, fax to 706-295-6944 or 706-764-
3707, deliver/mail to a Student Help Center listed below. Call 866-983-4682 if you have questions or need
assistance.
• Catoosa County; 6450 Alabama Highway; Ringgold, GA 30736
• Floyd County; One Maurice Culberson Drive; Rome, GA 30161
• Gordon County; 1151 Highway 53 Spur SW; Calhoun, GA 30701
• Polk County; 466 Brock Road; Rockmart, GA 30153
• Walker County; 265 Bicentennial Trail; Rock Spring, GA 30739
• Whitfield Murray Campus; 2310 Maddox Chapel Road; Dalton, GA 30721
Georgia Northwestern Technical College is a Unit of the Technical College System of Georgia and an Equal
Opportunity Educational Institution.
