Student ID

Student Name

In accordance with the federal Family Educational Rights and Privacy Act of 1974, amended, all information regarding a student’s financial information is considered private between the student and the college. A written release is required before the college can discuss this information with a third party. Parents, guardians or spouses cannot obtain information about your financial status from the college, because college officials cannot legally release such information without the student’s permission.

You may wish to waive this protection and permit the release of some types of financial information to certain people. Other offices on campus may also require a separate release form.

Email 

Phone Number

PLEASE CHOOSE AN OPTION:

I hereby authorize American International College to release any financial information contained in my student account records, both printed and electronic, to the designated persons listed below.

Name 1

Relationship 1

Phone 1

Name 2

Relationship 2

Phone 2

Name 3

Relationship 3

Phone 3

Name 4

Relationship 4

Phone 4

Name 5

Relationship 5

Phone 5

This authorization expires when I notify you otherwise in writing.

Electronic Signature Consent

By selecting the 'I Accept' button, you are signing this document electronically. You agree your electronic signature is the legal equivalent of your manual/handwritten signature on this document. You further agree that your signature on this document (hereafter referred to as your "E-Signature") is as valid as if you signed the document in writing. You also agree that no certification authority or other third party verification is necessary to validate your E-Signature, and that the lack of such certification or third party verification will not in any way affect the enforceability of your E-Signature or any resulting agreement between you and the American International College. You are also confirming that you are the student authorized to provide the data in this document. By electronically signing documents, you agree to all the terms and conditions of such documents as they exist on the date of your E-Signature.

Student Signature (Type in your legal name)

Please be patient. Form submission may take 30-60 seconds. You will receive a completion message when processing is completed.