RECORD AND AUTHORIZATION INFORMATION
INFORMATION CAN INCLUDE (Please check each box that applies for your information to be released.)
Academic Transcript Records
Records include transcripts, admissions & registration information, schedule information, Satisfactory Academic Progress status,
residency information and any other documentation contained in the academic records.
Financial Aid Records
Records include status of file, award and disbursement of funds information, Satisfactory Academic Progress status, income
information, and any other information contained in the application or financial aid file.
Disability Support Services Related Information
International Student Records
Records include Immigration and Customs Enforcement information.
Other Information: (Please specify)
DO NOT RELEASE ANY INFORMATION TO:
Under Public Law 104.208 Cascadia is directed by the federal government to provide the armed forces such information as name,
address, and telephone number, date of birth, level of education, major and/or degrees and prior military experience for all students.
I understand that when I select to opt out of releasing my information from the Solomon Amendment, I am also opting out of release
of information for career center information and opting out of having my name printed in the graduation ceremony name book, etc.
I, _______________________________________ (name), give Cascadia College my permission to release information to the
authorized person(s) as specified above. I understand that this Release of Information is valid until I withdraw the Release in writing or I
graduate from Cascadia. I understand that the Release of Information does not allow information to be released over the phone. The
authorized person(s) must come in to Kodiak Corner with photo ID for any release of information. I also understand this Release of
Information does NOT allow, authorize or enable any changes to my student record by any other individuals.
BELOW IS FOR OFFICE USE ONLY
Cascadia College is an equal opportunity institution and does not discriminate on the basis of race, color, religion, gender and/or sex, disability, national origin, citizenship
status, age, sexual orientation, veteran’s status, or genetic information. All Cascadia materials are available in alternative formats and can be requested by contacting the
Human Resources office.
RELEASE OF INFORMATION FORM/DO NOT RELEASE INFORMATION FORM
Cascadia College complies with the Family Educational Rights and Privacy Act (FERPA) of 1974. The FERPA Act
protects the privacy of student records with restrictions on disclosure of information. To authorize person(s)
with access to your student education record, you must complete and submit this form in-person to the
Kodiak Corner Front Counter with photo ID. See Cascadia’s website for additional information:
http://www.cascadia.edu/academic_resources/handbook.aspx
