Fillable Release of Student Records (Blackhawk Technical College)

Fill Online, Printable, Fillable, Blank Release of Student Records (Blackhawk Technical College) Form

Use Fill to complete blank online BLACKHAWK TECHNICAL COLLEGE pdf forms for free. Once completed you can sign your fillable form or send for signing. All forms are printable and downloadable.

Release of Student Records (Blackhawk Technical College)

On average this form takes 5 minutes to complete

The Release of Student Records (Blackhawk Technical College) form is 1 page long and contains:

  • 0 signatures
  • 6 check-boxes
  • 16 other fields

Country of origin: US
File type: PDF

U.S.A. forms for Blackhawk Technical College

BROWSE BLACKHAWK TECHNICAL COLLEGE FORMS

Related forms
Fill has a huge library of thousands of forms all set up to be filled in easily and signed.
Fill in your chosen form
Sign the form using our drawing tool
Send to someone else to fill in and sign.
find another form
 
6004 S County Rd G • PO Box 5009 • Janesville, WI 53547-5009
(608) 757-7660 • fax (608) 743-4407 • registration@blackhawk.edu
Last Revised: 3/26/2020 1
Release of Student Records
PLEASE PRINT
Last Name
First Name
Middle Initial
Date of Birth
Street Address
City
State
Zip Code
Email Address
Phone Number
BTC Student ID Number (if known)
I authorize Blackhawk Technical College to release information concerning the following student records:
_____ any and all records
_____ academic records (i.e. grades, transcripts, admissions records, course schedule, etc.)
_____ financial aid records
_____ student account records
_____ employment/education recommendation from: ________________________________________
_____ other records, specify: ___________________________________________________________
to: _____________________________________________________________
for the purpose of: _________________________________________________
I further authorize Blackhawk Technical College representatives to discuss those student records with the
above named designee(s). I will not hold Blackhawk Technical College liable under the Family
Educational Rights and Privacy Act (FERPA) for releasing my student records to the above named
designee(s). This release will be placed in my record and will be in effect for one year (five years for the
purpose of employment/education recommendations) from the date indicated below.
______________________________________________ _________________________
Student Name (Printed) Dated
______________________________________________
Student Signature
Send signed form to:
The Office of the Registrar
Blackhawk Technical College
6004 S County Road G
PO Box 5009
Janesville, WI 53547-5009
Download
Save PDF to desktop
Email
Email completed PDF
Send for Signing
Email for others to sign
Print
Print document
Choose a Field
Click on a field and
select the person that should complete it
Want to add a signature?
You can add a signature field
and assign it to someone else
to sign
Choose a Field
Click on a field and
select the person that should complete it

Release of Student Records (Blackhawk Technical College)

This document is locked as it has been sent for signing.

You have successfully completed this document.

Other parties need to complete fields in the document. You will recieve an email notification when the document has been completed by all parties.

This document has been signed by all parties.

Completed 27 July 2020

Message

View Audit Log
Print With Audit Log
Duplicate Document