Permission to Release Information
Student Name SMU ID or SSN
Email Phone
Purpose:
This form is to be used by Saint Martin’s University students to give permission to a third party for full access to the
records of the student during the effective dates listed on the form, as long as that third party can provide to SMU,
the relationship to the student and the password assigned specifically for him/her. Student records may include
academic performance (such as grades and GPA), class schedule, requesting enrollment verification and/or
transcripts. The release of this information to the third party will follow the standards and practices of the Registrar’s
Office, which is responsible for maintaining the current student’s academic record.
Directions:
Fill out this form in ink and return it via US mail or fax (include a clear copy of your picture ID) or bring it in
person to the Office of the Registrar (be prepared to show your picture ID)
Assign a different password for each person. The password should be one that will be difficult to trace to you
and must be between 6-9 characters. (Please do not use the number zero or the number 1 to avoid confusion
with similar letters)
If you assign an end date, the access will end on that day. Unless another form is submitted no further access
will be granted.
All start and end dates must include month, day, and year (mm/dd/yyyy)
I have read and understand the purpose and directions stated above. I agree to let Saint Martin’s University release
information as outlined above. I also understand that if the “end date” is left blank, this access will remain in effect
until rescinded in writing by me.
Student Signature Date
The following person(s) have access to my academic records:
Name
Relationship to student Password
Effective dates: Start End
(mm/dd/yyyy) (mm/dd/yyyy)
Name
Relationship to student Password
Effective dates: Start End
(mm/dd/yyyy) (mm/dd/yyyy)
