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Student Info Release Form Copy - Over 18

Header

Release of Student Information to Military Recruiters, College/University Recruiters or Prospective Employers Notification.

Text

Student Name:*

(Print Student Name)

Answer required for "Student Name:"

Student's Grade Level:*

(Print)

Answer required for "Student's Grade Level:"

Name of School:*

(Print Name of School)

Answer required for "Name of School:"

If student is 18 or older:*

Answer required for "If student is 18 or older:"

I am the student listed above and I am age 18 or over.

Please check ALL that apply:*

Answer required for "Please check ALL that apply:"

Military Recruiters: I do not want my name, address, and telephone number to be shared with military recruiters.

Institutions of Higher Education: I do not want my name, address, and telephone number to be shared with institutions of higher education.

Prospective Employers: I do not wany my name, address, and telephone number to be shared with prospective employers.

Student Name:*

(Print Name)

Answer required for "Student Name:"

Signature: (electronically typed or signed)*

Signature Required

Confirmation Email

Confirmation Email *

Answer required for "Confirmation Email"