Consent Form for Disclosure to Parents, Sponsors, and Recruiters

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Consent Form for Disclosure to Parents, Sponsors, and Recruiters

To: Registrar, University of Massachusetts Global (UMass Global)

Program Director, American Collegiate Live (AC Live)

Student Information

Given/First Name

Middle Initial

Family/Last Name

Student ID

Date of Birth

Month

Day

Year

Consent

If you agree that UMass Global and AC Live may disclose information from your education records to your parents/guardians, your sponsor (if applicable), and your recruiter, please sign the following consent:

I consent to the disclosure of any personally identifiable information from my education records to the individual(s)/organizations(s) named below, for reasons determined by UMass Global or AC Live as appropriate. I understand that the purpose of the disclosure is to inform the parties listed below of my progress and status at UMass Global, as well as any circumstances affecting my attendance at UMass Global. I understand that my education records may be disclosed to my Parents/Guardians through the Recruiter and that the Recruiter may only re-disclose education records to my Parents/Guardians identified below. This authorization will remain in effect for the duration of my tenure at UMass Global, but I may revoke the consent by written notice at anytime.*

I consent to the disclosure of any personally identifiable information from my education records to the individual(s)/organization(s) named below. (Please provide the information below and click "Submit."It is not required to fill all available fields.)I do not consent to the disclosure of any personally identifiable information from my education records. (Please click "Submit" below to record your response.)

Parent(s)/Guardian(s)

Name:	Email Address:
Telephone Number:

Name:

Email Address:

Telephone Number:

Financial Sponsor

Name:

Email Address:

Organization:

Telephone Number:

Agent/Education Counselor

Name:	Email Address:
Organization:	Telephone Number:

Submit

To complete the FERPA submission process, follow these steps:

Click the "Submit" button below.
Review your information on the form that opens.
Add your e-signature and click the "Submit Signed Response" button.
Once you have submitted your e-signature, a verification email will be sent to you. Click the link in the email you receive to complete the submission process.

*Students cannot be denied any educational services from UMass Global or American Collegiate Live if they refuse to provide consent.

Contact Information