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Online forms: Authorization For Release Of Information

Release Information

I release any information relating to my activities at Butler County Community College. This information may include such records as attendance, grades and grade point average, student standing, and payments collected or needing to be collected. This authorization will NOT give the Individual/School/Business access to my pipeline@Butler account.

NOTE: Because of FERPA (Federal Educational Right to Privacy Act) requirements, this release will not allow the Individual/School/Business to request any written information about me that could be released to a third party.

Copies of this authorization are as valid as the original release signed by me. This authorization is valid two (2) years from my signature date.

1. Which one of these applies to you? Required