Seattle Goodwill Industries
Career Pathways Program
Permission to Release Educational Records
Requested by (student):
Release to (agency):
____________________________________
Last Name
____________________________________
Last Name
____________________________________
First Name
____________________________________
First Name
____________________________________
Date of Birth
____________________________________
Organization Name
____________________________________
Student ID#
_______________________________________
Address
I give permission for ________________________________________________ [school name]
to release the specified information to the recipient listed above.
Education Records Information to be released:
Transcript
Grades
Financial Aid Status
Enrollment Information (status, classes enrolled in, wait list info)
COMPASS/CASAS/other placement test scores
Other (Specify: ______________________________________________________________)
Purpose of release: To confirm satisfactory progress for participation in the Seattle Goodwill
Career Pathways program.
This release will be in effect while I am a participant in the Career Pathways Program. I have
the right to invalidate this release at any time, but must do so in writing.
___________________________________________________
Student Signature
_____________________
Date