Prospective Students Release of Information Consent Form

Prospective Student

Release of Information Consent Form

I authorize releasing my education, training, employment, and other related information to Castro Valley Adult and Career Education to facilitate the services to which I may be referred. All agency and associated partners and their staff are bound by contract and by law to maintain my confidential information according to the standards set forth by the Federal Education Rights and Privacy Act (“FERPA”), by the California Education Code section 49073.1 and as appropriate, by the Health Information Privacy Protection Act (“HIPAA”).

FERPA allows schools to disclose those records, without consent, to the following parties or under the following conditions (34 CFR § 99.31):

o School officials with legitimate educational interest;

o Other schools to which a student is transferring;

o Specified officials for audit or evaluation purposes;

o Appropriate parties in connection with financial aid to a student;

o Organizations conducting certain studies for or on behalf of the school;

o Accrediting organizations;

o To comply with a judicial order or lawfully issued subpoena;

o Appropriate officials in cases of health and safety emergencies; and

o State and local authorities, according to specific State law.

This consent may be canceled at any time. Subject to cancellation, this consent form for data sharing will remain in effect for three years.

Student Information:

Phone Number: ______________________ Email address: _______________________

Gender: ▢ Male ▢ Female ▢ Non-binary

Birthdate: _____________

Other School(s) Attended: _______________________________________________________