Permission to Release Grade Information
Authorization of Grade Disclosure
I hereby authorize Central Washington University to release my grade reports, both quarterly
and accumulative grades, for the current academic year, to ________________________ for
the purpose of ______________________.
Requested By (Student):
First, Middle and Last Name
CWUID
Address
City, State, Zip
I understand that by signing this authorization. I am waiving my rights of nondisclosure of these
records under federal law only as to the organization listed. This release does not permit the
disclosure of these records to any other persons or entities without my written consent or as
permitted by law.
Student First and Last Name (Printed)
Student Signature
Date