Access, Opportunity, & Success Release Of Information Form

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Access, Opportunity, & Success Release of Information Form
Personal Release of Information Form
Confidential Information
RELEASE OF INFORMATION
Southwest Minnesota State University will certify that all student information provided for the AOS is kept confidential
and will not be released without permission.
AOS would like your permission to access and release family/student information for the following reasons:
1. AOS is required to report student eligibility and progress. This is done to demonstrate the programs
effectiveness during their Annual Performance Report and renewal of funding.
2. Southwest Minnesota State University in conjunction with the Financial Aid office will provide AOS with
eligibility information based off of the FAFSA and Financial Aid Award Information.
3. High school or college transcripts will be collected through AOS in order to verify GPA, class rank, ACT scores
and previous eligibility.
a. In the event that the student transfers, AOS will release a verification of participation status to the
institution at the student’s request.
4. AOS will monitor academic progress for the purpose of student continued academic success and possible
intervention by program staff.
By signing this document, I give AOS permission to access and release information on my behalf as stated in the
reasons listed above.
___________________________________________________
_______________
Student’s Signature of Release
Date
_________________________
Mustang ID
●Return to Academic and Diversity Resources● Southwest Minnesota State University●1501 State Street, IL 220●Marshall, MN 56258●
●Fax: 507-537-6027● Phone: 507-537-7382● Email: Michele.Sterner@smsu.edu ●

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