Release of Information Form

Release of Information Form
This form is to be used when a student wishes to disclose information to a third party (including parent/guardian/spouse).

The student must complete and submit the form.

The authorized person must present valid identification document when requesting information from the university.
Student ID Number*
Name*

First NameLast Name
Mobile No*
Format: (971) 000000000.
UOW University Email*
SOLSusername@uowmail.edu.au
Program*
1st Authorized Person *
Valid Identification Document*
2nd Authorized Person
Valid Identification Document
3rd Authorized Person
Valid Identification Document
I have read and understood the above and have been advised of my right to refuse such consent and the option of withdrawing my consent at any given time. I give my consent to the above-mentioned person/people voluntarily.
Signature of Student*

Clear
Date*

MonthDayYear
For detailed information regarding the University’s commitment to Privacy, please read the Privacy and Confidentiality of Student Personal Information policy available on myUOWD.
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