Records and Registration Office email@example.com 410-777-2243 410-777-2489 (fax)
WITHDRAW OF CONSENT
FROM AUTOMATED CALLS, EMAILS, AND TEXT MESSAGES
Use this form to revoke prior consent for automated calls, emails, and text messages generated
based on your student account. This does not revoke consent from automated text messages via
AACC ID# Legal Last Name Legal First Name M.I.
Phone Number Phone Type
Home Email Address
I request to revoke my prior consent for Anne Arundel Community College employees, agents and/
or contractors to contact me using automated telephone equipment, artificial or prerecorded voice
or text message, and personal calls and emails.
Signature-Physical Signature is Required Date
Notice of Nondiscrimination: AACC is an equal opportunity, affirmative action, Title IX, ADA Title 504 compliant institution. Call Disability
Support Services, 410-777-2306 or Maryland Relay 711, 72 hours in advance to request most accommodations. Requests for sign
language interpreters, alternative format books or assistive technology require 30 days’ notice. For information on AACC’s compliance and
complaints concerning sexual assault, sexual misconduct, discrimination or harassment, contact the federal compliance officer and Title IX
coordinator at 410-777-1239, firstname.lastname@example.org or Maryland Relay 711.
Records Office Use Only - Processed By Processed Date