I, {main_name} hereby authorize release of my educational and employment records to the Midwestern State University Student Support Services (SSS) program. The type of information that is to be released under this consent form includes:
· Transcripts
· School Enrollment Status
· School Credits Completed
· Degrees Earned
· Employment Status
· Employment History
· Disciplinary Records
· Recommendations for employment or admissions to schools
· Other Information Related to Education and Work Performance
The above information is to be released for purposes of verifying placement and retention in college and/or employment and for MSU SSSS program to provide support with retention in college and employment. This information will only be shared with program staff. I understand the information may be released orally or in the form of copies of written records, as preferred by the requester. I understand that I have a right to inspect any written records released pursuant to this Consent. I understand I may revoke this Consent upon providing written notice to MSU SSS program. I further understand that until this revocation is made, this consent shall remain in effect and my educational and employment records will continue to be provided to MSU SSS program for the specific purpose described above.